Bringing Sexual Orientation and Gender Identity Research to Budapest

September 27-28, 2019, scholars from around the globe will present their research, clinical experience, and views at the 2nd International Evidence-Based Psychotherapy for Gender and Sexual Minorities Conference in Budapest, Hungary. There are a number of factors giving rise to concentrated attention in the area of advancing sexual and gender minority psychotherapies. First, despite a lack of investment in clinical trials by major funders, the primary transdiagnostic mechanisms have been well-laid out and offer guidance in how to construct such interventions (e.g., Pachankis, et al., 2016; Pachankis, 2018). Though targets vary, both sexual minority stress and gender minority stress appear driven by internalized stigma, rejection sensitivity, concealment, misgendering, and overt discrimination or violence. Areas of intervention might target these directly, or well-supported underlying mechanisms that drive distress, such as emotion dysregulation.

The 1st international conference occurred in 2017 in San Jose, CA, with workshops from field leaders ranging from lore m. dickey and Diane Ehrensaft to Colleen Sloan, Adam Carmel, and Matthew Skinta. Discussions quickly began to select a venue outside of the U.S. as a follow up. The goal was to select a location where the very occurrence of a sexual and gender minority conference would have an effect on the community, a careful balance between a venue where the conference would push local discussions while simultaneously being a safe place for attendees to congregate, explore, and travel. The conference committee was also hoping to select a venue outside of the wealthiest nations that such conferences typically occur, as the price of both travel and housing would be just as prohibitive to those activist scientists and clinicians around the globe whether the conference were to be held in Tokyo, San Francisco, or Dublin. For these reasons, we were continually drawn back to Budapest. The city, and its own LGBTQ+ community, are progressive, open, and visibly present. An LGBTQ+ themed café rests against the bank of the Danube, windows open to the street, and travel and lodging in the broader region is quite inexpensive.

This is also a community under fire. Recent years have seen large donations fund the translation of books proposing sexual orientation change efforts by Charles Socarides and Joseph Nicolosi, Sr., into Hungarian. The right-leaning government banned the teaching of gender, effectively eliminating a top gender studies program at the Central European University (which has since relocated its main campus to Vienna due to sustained attacks on its credentials by the government). Secret and not-so-secret donors have funded pro-“conversion therapy” trainings and conferences at top medical schools. There is also a strong and vocal community of psychologists, like Dr. Andrea Ritter or Ádám Németh, who have acquired funding for the translation of APA materials on ethical practice and hosted local affirming conferences. This combination of a passionate local community and the targeting of the region by groups promoting LGBTQ+ animus were inspirational in selecting this venue.

 

In 2018, the conference company that had underwritten the first San Jose conference also hosted a weekend conference by a different name in New Orleans, LA. It followed more of an intensive training model, with a single series of keynotes and expert behavioral trainers such as Drs. August Stockwell, Matthew Skinta, and Colleen Sloan, as well as Worner Leland, MS. Though well-reviewed, this heightened the initial commitment to a full, multi-track conference such as occurred in San Jose that would allow for the sharing of ideas between clinicians and researchers that highlights current creativity in the field.

The upcoming conference in Budapest will feature workshops and talks from regional thought leaders, such as Richard Bränström on minority stress findings in Europe, Nicola Petrocchi and Hannah Gilbert on Compassion Focused Therapy, and Brigitte Khoury’s intersectional work on the needs of LGBTQ+ clients of Arab descent. Recently accepted workshops include guidance on trans affirming practice from August Stockwell and Worner Leland, and Jeremy Wernick and colleagues guiding the development of more trans affirming adaptations for work with serious mental illness. The deadline for panels, symposia, and posters is still open through the end of May, with discounted rates for those from emerging nations and for students. If you are interested or have any questions, please feel free to contact the conference organizing committee at sogdconference@gmail.com. To submit or register, visit sogdconference.dryfta.com.

LGBTQIA Affirming Ethics Across Fields

by Worner Leland, MS, BCBA and August Stockwell, PhD, BCBA-D, Upswing Advocates

As helping professionals working with marginalized populations, it is important to be cognizant of the ways in which the LGBTQIA community faces disparity in access to services from helping professionals, in spite of the disproportionate need. According to the National Association for Mental Illness, “LGBTQ individuals are almost 3 times more likely than others to experience a mental health condition such as major depression or generalized anxiety disorder,” (NAMI, 2018) and additionally, “LGBTQ youth are 4 times more likely and questioning youth are 3 times more likely to attempt suicide, experience suicidal thoughts or engage in self-harm than straight people,” (NAMI, 2018).

It is also important as behavior analysts to recognize that LGBTQIA affirmation is a behavior analytic issue. Some studies (George & Stokes, 2016) suggest a correlation between autistic traits and gender nonconforming identities, however many autistic transgender authors take issue with the current measurement system’s bias. Further research that centers transgender perspectives and neurodivergent perspectives is needed. However, the Asperger/Autism Network (AANE) notes that, “While many with Asperger/Autism firmly identify as heterosexual others firmly identify as gay, lesbian or bisexual. Still others may be more flexible regarding wh Howom they are attracted to; being sexually attracted to an individual for who they are as a person regardless of the other person’s biological gender, gender identity or gender expression. Other Asperger/Autistics may identify as Asexual or Aromantic in higher numbers than in the general population.”

When considering ethical behavior, behavior analysts look not only to our own code, but to codes of other helping professions, to guide our behavior. At the forefront is the commitment to avoid discrimination based on sexuality or gender, (BACB 1.05 c, d, e; APA 3.01; NASW 4.02; & NBCCC 26). This could look like refusal of care or harassment, however it may also be more subtle and include things like restricting gender presentation of a client, or targeting behaviors for decrease solely because they are gender non-conforming.

Secondly, it is crucial to act in the best interests of the client, (BACB 2.0; NASW 1.01, 1.14; & NBCCC 27). Regarding gender and sexuality, the best interests of our clients may differ from the wishes of parents, guardians, or others in the client’s environment. We must be willing to sit with the discomfort involved in navigating these differences while continuing to support our client.

Thirdly, it is important to disseminate behavior analytic ethics through engaging in social and political action, (NASW 6.04). The National Association of Social Workers provides excellent guidance, noting that [we] “should act to expand choice and opportunity for all people, with special regard for vulnerable, disadvantaged, oppressed, and exploited people and groups,” (b), and that also [we] “should act to prevent and eliminate domination of, exploitation of, and discrimination against any person, group, or class on the basis of race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, or mental or physical ability,” (d). This call to action necessitates not only advocating for our clients’ ontogenic rights, but behavior analytically bringing about change on a systemic, cultural level.

References:
American Psychological Association (2002). “Ethical principles of psychologists and code of conduct” (PDF). American Psychologist. 57: 1060–1073.
Behavior Analyst Certification Board (2016). Behavior Analyst Certification Board professional and ethical compliance code for behavior analysts.
George, R., & Stokes, M. (2016). “Gender Is Not on My Agenda!”: Gender Dysphoria and Autism Spectrum Disorder. In Psychiatric Symptoms and Comorbidities in Autism Spectrum Disorder (pp. 139-150). Springer International Publishing.
National Board for Certified Counselors. (2016). NBCC Code of Ethics.
Workers, N. A. (2008). NASW Code of Ethics (Guide to the Everyday Professional Conduct of Social Workers). Washington, DC: NASW.

Sex Toys and Safety

by Rayhana Ahmed, Sara Billings, and Alyssa DiDio, The Chicago School of Professional Psychology

Sexual stimulation, whether socially mediated or individually engaged in, frequently involves the use of sexual tools or toys, especially for women. In a 2009 study, approximately 40% of women reported use of a vibrator either alone or with a partner within the past month, and about 30% reported using a vibrator within the past year (Herbenick et al., 2009). Other research has determined that 48% of women used a vibrator ‘‘always’’ or ‘‘often’’ for solo masturbation and 25% used it ‘‘always’’ or ‘‘often’’ with a female partner (Schick et al., 2011). In spite of this data, there is little education around sex toy health and safety.

The Consumer Products Safety Commission (CPSC) estimates an average of 2,100 sex toy-related emergency room visits a year. According to Stabile (2013), “The authors concluded that injuries from sex toys increased sharply after 1999, possibly because more Americans began using them. The authors warned that the actual number of injuries was greater than reported in the study, because embarrassment about sexual injuries likely prevents many people from seeking treatment. Shame about sexual injuries also lengthened the average time that it took for patients to seek treatment, which could “result in the use of more invasive procedures to remove the foreign body . . . and [could] even lead to death due to complications.”

In addition to lack of information about safe toy insertion, a leading cause of emergency room visits, there is also little education around material safety in sex toy production. Because of cultural contingencies and cultural climate, to this day sex toys are viewed as a novelty item by the Food and Drug Administration. Because of a lack of FDA regulations on toy materials, many toys contain known carcinogens, or are made from porous materials which can easily harbor bacteria and transmit disease, (BadVibes, 2018).

Because of this, it is important for helping professionals to remain educated on sexual tool and toy use safety and best practices for health, and to have the capacity to disseminate this information to clients.

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SAFE SHOPPING

•Body friendly; Sex toys should be made of a medical or food grade material that is hypoallergenic and safe forintimate contact•The smell test; The easiest way to discern if a sex toy is made form a safe material is through smell. Unsafesex toys frequently have an obvious chemical or plastic smell.•Non-porous; Porous materials can harbor micro-organisms, such as bacteria, viruses and fungi, which can causeinfections despite even the most diligent cleaning efforts.•Form and function; Sex toys should be made by reputable companies that design and manufacture their toys tobe used sexually, rather than as gag gifts or “novelties.”
References and Resources
badvibes.org
Biesanz, Z. (2007). Dildos, artificial vaginas, and phthalates: How toxic sex toys illustrate a broader problem for consumer protection. Law & Inequality: A Journal of Theory and Practice, 25, 203-226.
Lee, S. (2016). Toxic toys, bad vibrations. CUNY Graduate School of Journalism, 1, 1-13. Quilliam,S. (2007). Everything You Ever Wanted to Know About Sex Toys But Were Too Afraid to Ask. Journal of Family Planning and Reproductive,33, 129-130.
Stabile, E. (2013). Getting the Government in Bed: Regulating the Sex Toy Industry. Berkeley Journal of Gender, Law & Justice, 28.

Pornography: History, Use, and Impact

by Madeline Boltin and Kelsey Lund, The Chicago School of Professional Psychology

Although sexual stimulation is a primary reinforcer, visual stimuli eliciting sexual arousal is still often a taboo topic. Understanding of the potential beneficial and harmful outcomes of pornography use can allow for practitioners to better advocates for clients’ rights to sexual health and to provide resources for maladaptive sexual behaviors.

Historically, erotic art dates back to ancient Greece and Rome, and has also been uncovered by archaeologists in other Asian, African, and European cultures. The Karma Sutra, a well known Indian tome outline different sexual acts and practices, dates back to the 2nd or 3rd century. Additionally, modern pornography is said to be the result of Victorian England (Ferguson & Hartley, 2009).

Possession of obscene pornography was originally categorized as criminal. Roth v. United States (1957) ruled that obscene material was considered to be material that was objectionable to the average person based upon community standards and where the media has only prurient and not artistic value. Miller v. California (1973) outlined more detailed guidelines as to what material could be categorized as obscene by stating that any media that ‘had undue interest in nudity, sex, or excretory functions and no redeeming social value were considered obscene’.

Research regarding the effects of exposure to pornography on sexual assault is inconsistent. Some believe that exposure to pornography increases negatives attitudes regarding sexuality and females. Some believe that exposure to pornography desensitizes and results in an increased risk of engaging in rape or sexual assault. On the other hand, pornography can be a way for individuals with built up sexual aggression to reduce their desire to engages in rape and sexual assault through viewing porn, (Ferguson & Hartley, 2009). In a literature review on the effect of exposure to pornography on sexual aggression , Seto, Maric, and Barbaree (2001) found no direct link between pornography use and sexual aggression. Most of the literature reviewed did no consider the link between individual characteristics and pornography exposure.

Pornography use does sometimes have maladaptive effects on viewers, including desensitization to sexual stimuli outside of pornographic context, negative body image perceptions, and unrealistic expectations about sex, (Owens, Behun, Manning, & Reid, 2012). However, pornography use may also have positive outcomes, including providing models for learning about sex, providing stimuli for discovering preferences, and facilitating sexual excitement with sexual partners. One Danish study (2008) found that both men and women who viewed porn had more satisfying sex lives, had healthier attitudes, and had healthier attitudes about the opposite gender.

It is important for helping professionals to consider the function of pornography use by clients. Recommendations for professionals include utilizing non-judgemental teaching about pornography. Rather than labeling porn as “good” or “bad” one can teach individuals how to talk about porn, to recognize differences between pron and reality, and to utilize porn in a way that is effective and healthy for the individual. Helping professionals may also recommend instruction-based sexual media for teaching specific skills such as masturbation. It is also recommended that helping professionals utilize resources that facilitate conversations around pornography versus real-life sexual situations. One such resource is Planet Porn. Planet Porn enables conversations around self-esteem, body image, boundaries, pleasure, consent, safer sex, emotions, relationships, gender, and sexual diversity. Additionally, it includes a discussion game where individuals have to decide if what is being described is sex you would see in porn, sex that would occur in a real situation, or sex that could occur with in both.

References
Ferguson, C. J., & Hartley, R. D. (2009). The pleasure is momentary…the expense damnable? Aggression and Violent Behavior, 14(5), 323-329.
Campbell, L., & Kohut, T. (2016). The use and effects of pornography in romantic relationships.Current Opinion in Psychology, 6-10.
Seto, M. C., Maric, A., & Barbaree, H. E. (2001).The role of pornography in the etiology of sexual aggression. Aggression and Violent Behavior, 6(1), 35-53.
Eric W. Owens, Richard J. Behun, Jill C. Manning& Rory C. Reid (2012). The Impact of Internet Pornography on Adolescents: A Review of the Research, Sexual Addiction & Compulsivity, 19:1-2, 99-122.
Matthews, A., & Probst, C. (2017, July 12). 20 Pornography Facts That Will Shock You.Retrieved April 01, 2018, from http://www.intellectualtakeout.org/article/pornography-facts-20-will- shock-you
Planet Porn – A teaching pack about porn, sex, sexuality and gender. (n.d.).

Sexual Orientation: Terminology and Models

by K. J. Comerford and Lawrence Platt, The Chicago School of Professional Psychology

What it is
Sexual orientation is “a component of identity that includes a person’s sexual and emotional attraction to another person and the behavior and/or social affiliation that may result from this attraction. A person may be attracted to men, women, both, neither, or to people who are genderqueer, androgynous, or have other gender identities. Individuals may identify as lesbian, gay, heterosexual, bisexual, queer, pansexual, or asexual, among others.” (APA, 2015).

Sexual orientation is different from gender identity, which can be described as “a person’s deeply‐felt, inherent sense of being a boy, a man, or male; a girl, a woman, or female; or an alternative gender (e.g., genderqueer, gender nonconforming, gender neutral) that may or may not correspond to a person’s sex assigned at birth or to a person’s primary or secondary sex characteristics. Since gender identity is internal, a person’s gender identity is not necessarily visible to others.” (APA, 2015).

Relevant Terminology
Aromantic: a term that describes having little or no romantic attraction to others. A person who identifies as aromantic may have sexual and emotional relationships with others, or they may not.

Asexual: a term that describes having little or no sexual attraction to others. A person who identifies as asexual may have romantic feelings for others and/or engage in sexual behavior, or they may not. Asexuality is different from celibacy.

Ace: a term that a person who falls on the asexual or aromantic spectrum might choose to use to describe their sexual orientation

Bisexual: describes having sexual, romantic, and/or physical attraction to two distinct genders, typically male and female

Demisexual: describes a sexual identity in which a person requires an emotional connection prior to experiencing sexual attraction

Gay: a term that is often used to describe an orientation in which a man is sexually, physically, or romantically attracted to another man, and in some cases as an umbrella term to describe various sexual orientations within the LGBTQIA community

Gray/Grey Asexual: a term that a person who falls on the asexual spectrum might identify with if they experience sporadic sexual attraction or engage in sporadic sexual behavior. This is different from demisexuality (see Demisexual).

Heterosexual: a term that most often is used to describe a man who has emotional and sexual attraction toward women (and typically not other genders), and a woman who has emotional and sexual attraction toward men (and typically not other genders)

Lesbian: describes a sexual orientation in which a woman is sexually and/or romantically attracted to women

Monogamous: umbrella term that describes having only one sexual and/or romantic partner at the same time

Non-monogamous: an umbrella term used to describe a person who does not identify as monogamous, who may or may not have more than one sexual and/or romantic partner at the same time

Pansexual: a term used to describe having sexual and/or romantic attraction for people regardless of their gender identity or gender expression

Polyamarous: describes an identity that involves having or being open to having multiple sexual or romantic partnerships at the same time, consensually. This is different from being polygamous, which is used to describe someone who has multiple spouses.

Queer: an umbrella term that some people who identify within LGBTQIA+ choose to use to describe their culture, gender identity, and/or sexual orientation. This term may be used to describe a person’s gender identity or sexual orientation. In the case of orientation, often times a person is sexually or romantically attracted to people who identify within LGBTQIA+. The term queer has a complicated history of being used as a derogatory insult, and for that reason, may people who fit these descriptions choose not to use the term to describe themselves. Others may use it to reclaim the term.

Questioning: a term sometimes used to describe the experience of uncertainty as it relates to gender identity or sexual orientation

Straight: See heterosexual

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MODALITIES

The Asexuality Spectrum
*It is important to note that this is a limited model and not all individuals who identify asasexual necessarily agree or identify with the definitions in this infographic.

The Gender Unicorn
The Gender Unicorn (above) is a gender and sexual orientation model by Trans Student Educational Resources (2014). Gender identity, gender expressions, physical attraction, and emotional attraction are marked on different continuums, and distinguished from sex assigned at birth. *It is important to note that this is a limited model that does not represent everyone’s identities or experiences.

The Kinsey Scale
*This is a limited model and may or may not be useful or relevant to an individual’s own orientation.

The Klein Sexuality Grid
*This is a limited model and may or may not be useful or relevant toan individual’s own orientation.
CLINICAL RELEVANCE & BEHAVIOR ANALYTIC APPLICATIONS
Providing relevant terminology and models related to sexual orientation is useful not only in the process of self-identification, but just as importantly, for the future of sex education and research. The misuse terms related to gender, sex, and sexual orientation is prevalent in research even today, and is problematic because this dissemination can cause harm to certain communities, and confusion about the language we use when advocating for our clients and their needs. Additionally, while many learners have diagnoses that limit physical and intellectual abilities, this shouldn’t limit them from being able to engage in consensual sexual behavior. Understanding and communicating sexual orientation is necessary to teach another person about sex, especially as it relates to consent, safety, and enjoyment. Providing multiple models of orientation and discussing each of their limitations can potentially be a straight-forward and useful approach to helping individuals understand and advocate for the many unique ways a person might identify. Per the Behavior Analyst Certification Board’s Code of Ethics (BACB, 2017), clients have a right to effective treatment, and for that to occur, behavior analysts must be informed and supportive of others’ safe practices and preferences as they relate to orientation and gender.

TIPS FOR PROFESSIONALS
•RESPECT. Always respect an individual’s identity. Sexual orientation is individualistic!
•KNOW YOUR COMPETENCY. Sex educators or sex therapists often have more resources and knowledge at theirdisposal and in most cases, practitioners should seek out specialist for issues regarding sexual orientation (Stein &Dillenburger, 2017). When in doubt, SEEK OUT!
•RESEARCH. Continue to read peer-reviewed articles pertaining to LGBTQIA topics. Ask questions. Attend seminars.Read blogs by people who identify as LGBTQIA. Perspective taking is important.
•PROVIDE RESOURCES AND TOOLS and remember to express their limitations. Models can be a helpful in self-assessment of sexual orientation, but they are all limited in their own ways.
•SPREAD THE KNOWLEDGE. Conversations about identity can be difficult and exhausting for folks who experiencelife in LGBTQIA+ identities. Help out by having difficult conversations with loved ones about why identities are important.

References
American Psychological Association (2018). Defining the limitations of language. Retrieved from http://www.apa.org/pi/aids/youth/sexual-orientation.aspx
American Psychological Association (2015). Guidelines for psychological practice with transgender and gender nonconforming People. American Psychologist, 70 (9), 832– 64. Retrieved from http://www.apa.org/practice/guidelines/transgender.pdf
The Behavior Analyst Certification Board (2017). Professional and ethical compliance code for behavior analysts. Retrieved from http://bacb.com/ethics-code/
Kinsey, A.C., Pomeroy W.B., & Martin, C.E. (1948). Sexual behavior in the human male. Philadelphia, PA: W.B. Saunders.
Klein, F. 1993. The bisexual option, 2nd ed., New York: The Haworth Press, Inc.
Mosbergen, D. (2013). The asexual spectrum: identities in the ace community (infographic). Huffington Post. Retrieved from https://www.huffingtonpost.com/2013/06/19/asexual-spectrum_n_3428710.html
National LGBT Health Education Center (2016). Glossary of Terms for Health Care Teams. Retreived from https://www.lgbthealtheducation.org/wp-content/uploads/LGBT-Glossary_March2016.pdf
Stein, S., & Dillenburger, K. (2017). Ethics in sexual behavior assessment and support for people with intellectual disability. International Journal on Disability and Human Development, 16, 11-17.
Trans Student Educational Resources (2014). The Gender Unicorn. Retrieved from http://www.transstudent.org/gender

National Hotlines
LGBT Helpline (Ages 25+)
(888)340-4528 or (617) 267-9001
Peer Listening Line (Ages 25 and Under)
(800)399-PEER or (617) 267-2535
Gay, Lesbian, Bisexual and Transgender National Hotline
1-888-843-4564 Email: help@GLBThotline.org
Trans Lifeline
(877)565-8860