We were fortunate to have Betty Berzon, PhD address the attendees, who presented a personal review of how she became involved in gay, lesbian and bisexual activism in mental health practice. In a speech that was just as inspiring as it was pertinent to the theme of this conference, Dr. Berzon prefaced her address with the statement that there is a new interest in the history of the gay, lesbian, and bisexual community. As she recounted her initial contact with the community in the early seventies, she described her effort to find other gay and lesbian psychotherapists in the mental health community at the American Psychological Association's annual meeting in Washington, DC, in the summer of 1971. Together, she and Don Clark, PhD had, "like thieves in the night" hung make shift banners on each floor of the hotel at which the conference was being held announcing "Gay and lesbian psychotherapist meeting tonight at 6:00 in room 615." They sat in room 615 wondering what would happen that night.  Sure enough, at 6:00 there was a knock on the door, and soon the room was filled with men and women talking. This prefaced the event of November 1972, when she entered the Ambassador Hotel in Los Angeles for a panel discussion of gay and lesbian psychotherapists, the moment in her life when she knew that activism would be a fundamental part of her work.  Dare we say that the rest is history. And a most laudable one, at that.

Throughout the speech, Dr. Berzon's personal thoughts evoked laughter with in those early days, striking a familiar chord with those who's eyes are wide open when first coming out to themselves. As most of those hearing her words recognized the message that the early days of activism in mental health was focused on trying present the community as it truly was, rather than to be cowed into the notion that the all straight professional community had created for us. This would directly challenge everything that the science of psychology held as doctrine, even after the 1973 "instant cure" by the American Psychiatric Association's removal of homosexuality from the DSM. This challenge continues today, and she keeps on fighting the good fight, as can be seen her various publications, to which she is about to add her autobiography.

This understanding of her role in the history of the interaction between the community and the mental health profession was definitely acknowledged in the question and answer period following her remarks. In response to the question presented to her by John Jones, MFT, an attendee, when he asked what is the one area we need to focus on, Dr. Berzon responded that we "need to challenge our own community. There is no grassroots organization nowadays."  She commented that most gay rights organizations look too much like corporations involved in a business. She further explained that we need to become active and stay involved in the community. She stated that activism "makes me a healthy gay person." This was dovetailed with the statement that society only responds to violence.  Quickly reminding the listeners that she does not endorse violence, she explained that when Matthew Shepard was killed, the news was front page material throughout the mainstream media of most first world countries. The violence she referred to was that which is exacted upon us, a stark reminder of the role that we need to remember we play in society, in bringing the community together, and not only responding to homophobia in our daily lives, but working together to prevent further dissemination of homophobia in the mental health profession.

The audience hearing this message was enthusiastic in it's applause at the conclusion of her remarks, and continued to express their support and appreciation for her message in the evaluations received at the end of the conference. Given the high level of adulation Dr. Berzon's address received, it is appropriate to state that her comments have inspired and activated a serious body of mental health professionals who share her vision and whether or not they have done so before, are galvanized to become visible members of the gay, lesbian, and bisexual mental health community.

By Any Other Name
In our first round of sessions, the rather popular course presented by Greg Carlsson, MA, titled "Bisexuality 101: Just a Passing Phase or a Real Orientation", began by stating that this rather complex discussion. Stating that bisexuality is not gendered based, whereas homosexuality (and heterosexuality) is, it is about looking at the person as a whole, rather than at their gender. Mr. Carlsson, an MFT intern in Pasadena, shared his own experiences in bisexuality, which enhanced an already gripping presentation as to how to help a client in their self identification, and the pitfalls that are inherent in the question of sexuality.  Encouraging the audience to "get information from client as to what bisexual means rather than placing our own preconceived notions on them," he reviewed a relatively comprehensive compendium of terms and concepts involved in the discussion of bisexuality, some terms which had obviously not been heard of by most audience members, given the reactions that many expressed during the discussion. This presented a rich arena for sharing the experiences that many attendees have had in trying to address bisexuality in the clinical and paraclinical settings they find themselves in.

Further explaining that society is basically dichotic, either this way or that, Mr. Carlsson stated that bisexuality challenges this way of thinking, and that poses as the basis for much of the bias it faces, from the gay community as well as the nongay community.  This can confuse the individual who is struggling with their sexuality which is a self identifying component of their personality. The confusion stems from questions such as "How do I know that I am bisexual?  Am I just commitment phobic?" Also, this can lead to clients not telling their therapist that they are bisexual or that they are trying to figure out whether or not they are bisexual.

Mr. Carlsson made available many resources for therapists working with bisexual questioning or identified clients, which are largely not known of or easily found. Among these resources are various materials including the internet binet.com. Reviewing the comments offered in the evaluations, this course challenged preconceived notions as well as offered a solid schematic for discussing bisexuality with clients, colleagues, and the community.

Authentic Empathy
Across the hall, in a rather intimate setting for discussion, Anthony Zimbardi, PsyD, MFCC and Ken Howard, LCSW presented an empowering session titled It Takes One to Know One: Issues In Identification and Countertransference with Gay/Lesbian and HIV Positive Clients and Their Therapists. As the title suggests, this discussion centered on the relationship between the HIV positive person and their therapist, when the therapist is either HIV positive or not, and how that impacts the therapeutic climate.

Through the use of personal stories, highlighting the literature focused on this issue, Dr Zimbardi explained that "authentic empathy," when the therapist understands the client because they have had similar experiences, rather than having to learn from the client the innuendo, nuances, and other elements, fundamental and peripheral. Mr. Howard predicated this with the statement that the therapist has to know the issues relevant to the client's point of view.

As this relates to therapy with persons who are HIV positive, in that in many cases, there may be times when the therapeutic setting has to be in the person's home, which presents a new set of boundaries and calls for a radical approach to therapy, especially if the person's condition deteriorates and the therapy becomes a time to help the person prepare to die."It means holding their hand, talking with them, crying with them, and being there with them", Dr. Zimbardi related as he shared a story about a young man's dying experience. "His mother called me and said that he wanted to see me. When I got there, I held his hand and listened to him, until after a while I went into the kitchen with his mother who said to me that she was having difficulty losing her best friend, whom she had brought into the world thirty-seven years prior. When we went back into the living room where the hospital bed had been moved to, we discovered that he had died."

Mr. Howard shared that the counter-transference issues which can occur stem from the impact that the AIDS epidemic has had on the community. "Larger number of people are dying younger." This can lead to anxiety and distress over helping our clients to make the right decisions for their health. When the client participates in activities that jeopardize progress, it can lead to great tension. As Dr. Zimbardi said, "I want them to have the same desire [to live] as I have." In conjunction to this point, Mr. Howard shared the realization that he has had working with this community, stating that he sees his role in the context that "We can't take away HIV, but if we can make it a little less horrible, mitigate the pain, then we are doing our best work."

Recognizing Our Humanity
Sharing the session with Dr. Zimbardi and Mr. Howard was Stuart Altschuler, MFCC, who addressed self care for the therapist working in the gay, lesbian and bisexual community. Opening his remarks with the statement that "We are human first, therapist second," he proposed that we recognize our humanity. What happens when we're feeling shaky and we have a solid identity in the professional community?  This was especially important to review when Mr. Altschuler shared his experience of trying to find a therapist who did not already have a pre-conceived notion of who he was or the work that he did, that it was a difficult task, one which paid off when he did find one.This was a necessity in the experienced a great deal of loss in the deaths of many of his friends. The year of death that was 1994-1995 involved visiting many friends in the hospital and going to funerals.  He soon realized that if he wasn't attending to either of these, he was sitting at home in front of the television. He searched for a therapist to help him move the grief along, and found it in EMDR.

Mr. Altschuler discussed how he did not like the term "burnout" as it implies that we are doing something wrong in our self care. Rather, a more appropriate term for what we may be experiencing is "compassion fatigue," introduced by Charles Figley, who, Mr. Altschuler explains, stated that we, as caregivers, are compassionate beings. For those who work in the HIV community, we are exposed to many fragile experiences, and this can have a profound effect on us.

"The key" Mr. Altschuler says, "is balance and teaching how to find it." This involves assessing what tools we possess, and those we don't. Also, this compels us to ask the question, "What are we resisting, or are in denial about, hurting from?"  As Mr. Altschuler answered that, he stated that we need to "Tell the truth faster," this way we do not afford denial the opportunity to get in the way of addressing what is hurting us. "This can be out of fear of revisiting old relationships, old hurts" he says, and that prevents us from finding the balance we need.

Love @AOL
In the afternoon session, the discussion about bareback sex (defined at this session as anal sex without a condom) was surrounded by great energy and interest in the gay male sex life. Recent literature in popular journals has been widely focused on this discussion, and has leant a great deal to be discussed. Gregory Cason, PhD, the facilitator of this session, who had also created a panel of men who are involved in relevant aspects of this discussion, opened his remarks with information he had found on the internet, primarily through America OnLine profiles as well as a brief survey he created for online users to respond to. The information he retrieved from both venues was overwhelming in the revelations it brings.

Dr. Cason received over one hundred responses to his survey, and some of the statistics that he shared with the audience was that the average age group ranged from thirty to thirty-nine, mostly some college experience through master's level educated, predominantly white, identifying themselves as spiritual though not religious, and related that they had an annual income of fifty to one hundred thousand dollars a year.  The general response to his survey was that those who bareback are interested in what's going on in their community.Dr. Cason found very few respondents who identified as other than gay men, as well as explaining their bareback experience as working with the HIV community. "I wanted to see if this was a 'in the heat of the moment' thing, or was this a decision they had made."  Mostly, it was intentional. The persons who responded preferred sex without condoms, and were eager to share this with Dr. Cason. This provided Dr. Cason with the opportunity to discuss harm reduction (you can read Dr. Zimbardi's article on Harm Reduction in this issue), which stresses caution over abstinence, and attempts to educate the person participating in dangerous activities how to protect themselves, as well as helping them become aware of the consequences if they do not take cautious measures, such as having condom protected sex with only one partner who is HIV negative, and keeping oneself regularly tested.

The panel, comprised of Jeff Bailey, Coordinator of HIV Prevention and Education at the Gay and Lesbian Center, and Tony Valenzuela shared their experiences of working with men who bareback, and how this brought them to working with the HIV community. Mr. Bailey described the current programs available for educating men about the risks involved in bareback sex, and the overwhelming number of men who participate in this sexual expression without being aware of the risks, or take them seriously, given the variety of HIV drugs. One panelist, Tony Valenzuela, challenged the attendees about monitoring the role of mental health professionals. "The initial response of the mental health community, when I came out as [HIV] positive was that I had low self esteem or that I was self destructive, and that was not the case."  He further stressed that the mental health community needs to get behind persons like him and help them make educated choices. 

Grief Stricken
Sandra Jacoby Klein gave an extremely informative and thorough presentation of the unique and complex issues confronting gays, lesbians and bisexuals in their grieving process, in her presentation, Gay, Lesbian and Bisexual Grievers: Enfranchising and Embracing Their Diversity. Ms. Klein also provided numerous treatment recommendations for professionals when responding to the unique patterns of grief presented by this population. Ms. Klein identified the multiple factors that cause gays, lesbians, and bisexuals to feel disenfranchised in their experience of grieving, stemming understand them. Ms. Klein offered her view that for treatment to be truly effective, the therapist must gain a thorough understanding of the client's unique experience to their loss and assist them in discovering ways to overcome their sense of disenfranchisement so as to be able to openly and fully express their grief.

Ms. Klein shared insight into how clients can protract their grief for years without discussing their loss, whether it be the death of a partner or the end of a relationship, with their psychotherapist. This stems from the widespread belief that mainstream institutions not only do not care to hear about this loss in their lives, but that such relationships are held in great disdain. Though current popular media is bringing a more positive light to these relationships, there is still a pervasive understanding in the gay, lesbian, and bisexual community that such discussions are still taboo.

Being gay, lesbian, and bisexual psychotherapists, we stand in a special role to help those who have carried the pain of loss for years, even decades, to find a safe place to process their grief and regain a place in their lives and allow for intimate relating to happen once again. As one attendee stated at the conclusion of this session, "I never realized that there was such a population among us, but it makes so much sense when I consider our place in society still and the access we have to resources for the grief involved in our relationships."

As we review the evaluations from those who attended, we are grateful for the generous remarks we receive, and are taking each suggestion for changes or enhancements into serious consideration. Please be sure to make a note that our Sixth Annual Conference will be held on Gay Pride Weekend, Los Angeles, in 2000. More information will be made available as to the date and format with the call for proposals, which will be published in Fall of this year. Given the high quality of proposals we were fortunate to receive this year, we are encouraged as to what will be made available next year.

Also, we wish to thank Ken Howard, LCSW for his invaluable work in securing much needed funding for this conference through the City of Los Angeles. Without efforts like his, and the rewards that come with such care, we could not bring to you the conference that we did and are looking forward to bringing you in the future. We hope to see you next year, and ask that you let your colleagues and friends know about the conference, and get them to participate.