Developing an Inclusive Model of Young Heterosexual and Sexual Minority Women's Sexual Decision-Making.

Efforts to improve sexual health outcomes among young cisgender women require in-depth understanding of how women with diverse sexual identities make decisions about their sexual health. We conducted semi-structured interviews with 31 young cisgender women with diverse sexual identities and histories (age range 18-29 (M = 23.32); 81% White; 29% bisexual, 26% heterosexual, 16% lesbian, 13% queer, 10% pansexual, 3% gay, 3% demisexual) about their decision-making surrounding sexual risk reduction. By conducting thematic analysis, we found that, regardless of partner sex or gender, women adapted sexual health strategies based on how much commitment, trust, and communication existed in their relationships. Because heteronormative structural influences limited access to information and safer sex options, women had to rely on trust and communication more with other women and partners with vaginas, compared to men and partners with penises. Women did not consider safer sex strategies with partners with vaginas (e.g. hand washing) risk-reduction techniques; instead, they considered them general hygiene or a way to take care of a partner. We propose that an inclusive model of young women's sexual decision-making should: (a) highlight the influence of relationships; (b) frame prevention in terms of overall health instead of pregnancy and STIs; and (c) acknowledge that structural factors, such as heteronormativity and sex-negativity, constrain women's decisions.

Adolescent Sexual Development: A Family Perspective.

Adolescent sexual development is informed by individual, relational, generational, institutional, and cultural perspectives. Families matter: they are the social institution at the intersection of adolescent development and broader social systems, charged with the responsibility for rearing children and adolescents to adulthood. This narrative review maps insights from family theory and research onto adolescent sexual development research. Our purpose is to inform sexuality researchers from diverse fields about how family perspectives can enrich understanding of adolescent sexual development. We present the critical, intersectional theoretical framework guiding this review as consisting of three meta-themes for understanding families through an examination of family structure, process, and context. Then, we apply those meta-themes to current research on adolescent sexual development by selectively organizing our review around the contexts of family structural diversity and family relational complexity, demonstrating that both the structure and the process components are embedded within the intersectional and cultural contexts that shape and are shaped by families. Our review demonstrates that diverse, intersectional family structures and transitions may affect adolescent sexual development by influencing family processes, particularly around sexual communication. We conclude with implications of using family perspectives for future inquiry related to adolescent sexual development.

Risk and Resilience Factors for Mental Health among Transgender and Gender Nonconforming (TGNC) Youth: A Systematic Review.

In recent years, there has been a proliferation of research regarding transgender and gender nonconforming (TGNC) people. The stigma and legal discriminations that this population faces have obvious and documented repercussions for mental health. In 2015, the American Psychological Association (APA) published Guidelines for Psychological Practice with TGNC People. The APA noted that due to the nuances of working with TGNC youth and the dearth of related literature, the guidelines focus primarily on TGNC adults. To date, there has not been a systematic review of risk and resilience factors for mental health among TGNC children, adolescents, and young adults under the age of 25. Forty-four peer-reviewed articles met inclusion criteria for this systematic review, and were evaluated for their methodological rigor and their findings. Common risk factors for negative mental health variables included physical and verbal abuse, exposure to discrimination, social isolation, poor peer relations, low self-esteem, weight dissatisfaction, and age. Across studies, older children and adolescents tended to report higher rates of psychological distress. Resilience-promoting factors for mental health were also documented, including parent connectedness, social support, school safety and belonging, and the ability to use one's chosen name. By synthesizing the existing literature using a resilience-focused and minority stress framework, the present review provides clinicians and researchers with a coherent evidence-base to better equip them to promote psychological adaptation and wellbeing among TGNC youth.

Youth Disclosure of Sexual Orientation to Siblings and Extended Family.

OBJECTIVE: To explore the processes and experiences associated with disclosing sexual orientation to siblings and extended family. BACKGROUND: Few studies prioritize the experience of disclosing to siblings and extended family, despite its frequency and potential impact on the family unit. Extended family members often act as sources of support for youth; it is therefore worthwhile to consider whether this remains true during and after disclosure of sexual orientation. METHOD: Interview and questionnaire data were gathered from 22 lesbian, gay, bisexual, and queer (LGBQ) youth, 14 to 21 years of age, from a large Midwestern city. Constructivist grounded theory informed the qualitative methodology and data analysis. We build on concepts of horizontal and vertical family relationships by also introducing the concept of diagonal relationships. RESULTS: Participants described their relationships with aunts as possessing characteristics of horizontal and vertical relationships, allowing them to act as moderators and mediators of the parent-child relationship. CONCLUSION: The concepts of vertical, horizontal, and diagonal relationships take into consideration how the structure (e.g., hierarchy, egalitarianism, boundaries) and nature (e.g., closeness, reciprocity, mentorship) of various relationships shape the coming-out process for LGBQ youth, without dismissing the importance of either immediate or extended family members. IMPLICATIONS: The emerging conceptualization can guide services and interventions as well as illuminate further research on the family systems of LGBQ youth.

What sexual minority youths want in a program to assist with disclosure to their family.

Disclosing one's sexual orientation to family members can be a difficult process for sexual minority youth (SMY). There are many decisions to make and factors to consider, such as whom to tell first and how family members may react. SMY are in need of resources to help them through this process, including programs that help them to make decisions about safe disclosure. Through interviews and open-ended surveys with 48 participants, the authors found that overall, SMY want a program that helps them connect with others. There were no strong preferences for facilitators' gender, and participants differed in opinions on facilitators' sexual orientation. However, most agreed that they would like a program that provides education and the opportunity to hear from and share stories with others.

Challenges and Strategies of Sexual Minority Youth Research in Southwest Virginia.

A research team that works on scholarship related to sexual minority issues has been conducting research and recruiting participants since the fall of 2012. In the years since the team was formed, there has been a variety of challenges with recruitment, approval for research through the Institutional Review Board, gaining access to the lesbian, gay, bisexual, and queer (LGBQ) community, and general mistrust of researchers. Using concepts from feminist-informed qualitative research methodology-including reflexivity, positionality, and engaging in research with individuals from marginalized communities-we present reflections on some of the methodological challenges the research team has encountered while trying to conduct LGBQ research in southwest Virginia. This article encompasses the viewpoints of multiple members of the research team, including those who are faculty, graduate students, and undergraduate students with identities across the sexual orientation spectrum.

Deciding to Come Out to Parents: Toward a Model of Sexual Orientation Disclosure Decisions.

The purpose of this study was to conduct research to understand nonheterosexual youths' decision to disclose their sexual orientation information to their parents. The sample for this study includes 22 youth between the ages of 14 and 21. Constructivist grounded theory guided the qualitative methodology and data analysis. The findings from this study posit an emerging model of sexual orientation disclosure decisions comprised of four interrelated factors that influence the decision to disclose or not disclose, as well as a description of the mechanism through which disclosure either does or does not occur. Clinical implications and recommendations for further research are provided.

Becoming the Parent of a GLB Son or Daughter.

Recent research has documented the importance of parental reactions to disclosure for sexual minority youth (SMY) (e.g., Ryan, Huebner, Diaz, & Sanchez, 2009). The purpose of this study was to develop a deeper understanding of the parent perspective of the disclosure to family experience of SMY ages 14-21. In-depth interviews were conducted with eight parents in the United States who had experienced a child disclose their lesbian, gay, or bisexual (LGB) orientation to them. Constructivist grounded theory and symbolic interaction theory informed the methodology and data analysis for the project. Analysis revealed that the process of becoming the parent of an LGB son or daughter is an appropriate narrative to conceptualize the parental experience of the disclosure to family process. The findings highlight how disclosure introduces new roles into the existing family system, which affects the consideration and interpretation of the salience of particular identities, such as being the parent of an LGB son or daughter. Understanding how parents experience the disclosure to family process - particularly, how they understand and re-envision the meaning of being a parent - is crucial for research and intervention to help families become supportive of SMY. Limitations and suggestions for future research are presented.

Coming out of the dark: content analysis of articles pertaining to gay, lesbian, and bisexual issues in couple and family therapy journals.

The present study seeks to extend previous research regarding literature related to gay, lesbian, and bisexual (GLB) issues published in couple and family therapy (CFT)-related journals by presenting the results from a content analysis of GLB studies in CFT-related journals from 1996 to 2010. Results of the analysis revealed a 238.8% increase in total GLB content published since the original review. Articles pertaining to therapy with GLB clients continue to represent the largest area of publication. With one exception, all surveyed journals showed an increase in the percentage of GLB content since the first study. Emerging areas of research include studies related to supervision and training, GLB mental health and substance use, and sexual minority adolescents. A movement away from deficit-based perspectives could open a new lens on family life.

Alliance and termination status in couple therapy: a comparison of methods for assessing discrepancies.

Much of the empirical data available about therapeutic alliance and its relationship to termination status come from individual psychotherapies. We know less about therapeutic alliance in couple therapy. A unique characteristic of alliance in couple or family therapy is the possibility of discrepancies in alliance between system members. In this study we sought to demonstrate three statistical techniques: standard deviations, the intraclass correlation to assess discrepancies in alliance over time during the initial stage of couple therapy, and the use of these various measures to predict termination status using a sample of 72 couples from a university-based training clinic. Differences in partners' alliances operationalized either as categorical or continuous variables but when analyzed separately at each time point were not predictive of termination status. When multilevel modeling was used, a difference in the way the discrepancies changed over a period of time was related to termination status.

Trajectories of therapeutic alliance in couple versus individual therapy: three-level models.

Research concerning therapeutic alliance and outcome is prevalent but relies heavily on data from individual treatment. In this article, the authors present data from cases in which an individual was seen and cases in which a couple was seen in order to investigate differences in therapeutic alliance and its trajectory depending on case type, therapist experience, and therapist sex. Participants included 96 couples and 52 individuals with 15 therapists from a large Midwestern training clinic for couple and family therapy. Data include the use of the Working Alliance Inventory-Shortened Version, and three-level models were estimated using hierarchical linear modeling. The results highlight differences in the trajectories of individual and couple clients' therapeutic alliance, including evidence for a curvilinear trend in work scores for individual clients but not couple clients. The results also highlight differences in the sources of variation for couple cases versus individual cases. There is clearly complexity in the building of alliance with clients in general, and even more so with couple clients.

Stressors and coping strategies for HIV-test counselors giving rapid HIV-test results: an exploratory qualitative study.

Stress has been extensively researched in the HIV services field. Yet, research regarding stress related to HIV-test counseling has solely focused on stressors related to giving results, even though stress on the HIV test counselor can occur at many points within a counseling session. This exploratory, qualitative study examines the stressors faced and coping mechanisms utilized by HIV-test counselors at AIDS service organizations (ASOs) during rapid HIV-test counseling sessions. Forty-two HIV test counselors were interviewed regarding HIV-test counseling sessions in which they provided preliminary-positive/reactive, negative/nonreactive, and invalid results. Regardless of the test result, HIV test counselors faced stressors, including giving HIV test results; dealing with emotions; difficult clients; self-doubt; and systemic stressors. Most stress was managed through social support, preparatory coping strategies, respite, and putting things into perspective. Despite the exploratory nature of the study, the findings suggest that strengthening support bases and improving current training standards will increase the well-being of HIV test counselors.

Does family matter to HIV-positive men who have sex with men?

Most studies have indicated that friends or families of choice provide more support to HIV-positive men who have sex with men (MSM) than members of the family of origin. The creation of families of choice by MSM has been viewed as a means of creating a support system in the absence of traditional family. The purpose of this study is to explore if HIV-positive MSM believe family of origin is important. Data were drawn from a qualitative study of HIV disclosure to family. Responses to the question, "How important is family to you?" are explored. Results suggest that for many HIV-positive MSM, relationships with family of origin are very important. While not definitive, data to be presented are provocative and challenge notions of the significance of family of origin to marginalized populations.

The impact of initial factors on therapeutic alliance in individual and couples therapy.

The study uses 457 clients to investigate the impact of initial client factors on the development of therapeutic alliance. Data were collected longitudinally over the early portion of treatment. Cases included both individual and couple clients, allowing for examination of differences by case type. The study used the Working Alliance Inventory-Shortened Version (Tracey & Kokotovic, 1989) to measure therapeutic alliance. Initial factors considered included age, differentiation levels, prior stress, and depression. Couple clients showed differences from individual clients, and the variability prompted further investigation into relationship satisfaction and commitment as factors influencing the development of therapeutic alliance. Results highlight the increased complexity of developing an alliance with couples, and recommendations are provided for clinicians.

An intervention to assist men who have sex with men disclose their serostatus to family members: results from a pilot study.

The purpose of this study was to evaluate the efficacy of an intervention to assist HIV positive men who have sex with men (MSM) in forming and executing strategies for the disclosure of their serostatus to their families of origin. Results indicate that the intervention was successful in assisting men with the primary outcome of disclosure. Participants reported no regret with disclosures occurring during the intervention and follow-up period. Effects on secondary outcomes including family functioning, depression, loneliness, and perceived social support were inconclusive. Implications, refinements of this intervention, and suggestions for future disclosure research are provided.

Comparing regret of disclosing HIV versus sexual orientation information by MSM.

Very little research has been conducted focusing on regret associated with disclosing either HIV-positive serostatus or sexual orientation information. The purpose of this study was to investigate the prevalence of regret related to the disclosure of serostatus and sexual orientation to family members among HIV-positive men who have sex with men (MSM) and to further explore the participant, family member, and relationship characteristics that influence the likelihood of experiencing regret. Almost half of participants indicated no regret with the disclosure of either HIV-positive serostatus or sexual orientation. Among those that did experience some regret, the prevalence of regret with at least one family member was similar for HIV-positive serostatus (39.4%) and for sexual orientation (37.3%). Suggestions for professionals working with HIV-positive MSM and implications for future research are presented.

An intervention to assist men who have sex with men disclose their serostatus to casual sex partners: results from a pilot study.

This article reports pilot data from a newly developed disclosure intervention and associated measures specifically tailored for disclosure to casual sexual partners. Treatment consisted of a four-session, theoretically driven intervention focusing on the costs and benefits of disclosure. Using a randomized control, crossover design 77 men were randomized into one of three conditions (wait-list control, facilitator only, and computer and facilitator). Results of the study suggest that facilitated administration of the pilot intervention was effective in reducing mean scores on the HIV disclosure behavior and attitude scales and that these reductions were both statistically and practically significant.

Methods of promoting safer sex behaviors utilized by men who have sex with male casual sex partners.

The purpose of this article is to report results of a qualitative investigation into the methods that HIV-positive men who have sex with men (MSM) use to initiate safer sex with casual sexual partners. In-depth, qualitative interviews were conducted with 57 HIV-positive adult MSM living in a large midwestern city. Using an inductive approach to data analysis, participants revealed a typology of safer sex strategies that can be placed into four primary categorizations: having a nonnegotiable sexual behavior policy, behaviorally controlling the interaction, being verbally direct, and being verbally indirect. Strategies varied by degree of explicitness and partner involvement. Men in this study often employed multiple strategies if their partner was not initially receptive to engaging in safer sex behaviors. The strategies described can be especially beneficial to those working in the area of HIV prevention. Providing MSM a variety of options to initiate safer sex may enhance current prevention efforts.

A systematic review of the research base on sexual reorientation therapies.

In the past few years, members of the AAMFT, like members of other professional groups, have engaged in a discourse as to the necessity and effectiveness of sexual reorientation therapies. The purpose of this article is to review, critique, and synthesize the scientific rigor of the literature base underpinning sexual reorientation therapy research. Using a systematic narrative analysis approach, 28 empirically based, peer-reviewed articles meeting eligibility criteria were coded for sample characteristics and demographics as well as numerous methodology descriptors. Results indicate the literature base is full of omissions which threaten the validity of interpreting available data.