This year’s conference had more workshops than past years, a more diverse attending population, and the subjects discussed covered a wider range of clinical interest. This was the first year that the conference was cosponsored by Tarzana Treatmen Center, a most generous and   auspicious partner in bringing to you the kind of conference you deserve. The theme of the conference, "On the Cutting Edge: 2000 and Beyond", reflected the hope that we have of the promises which the new millennium has to offer. When science and art meet there is a sense of endless possibilities that the needs of the people we serve will be met in a thorough and effective manner, and that we can expand our abilities to include new and wonderful methods of meeting these diverse and growing needs. The workshops spoke to this, and as you will read, they met the challenge to help the attending clinician to enter the new era with greater agility.

In the workshop, Domestic Violence in Gay and Lesbian Relationships, the presenter Susan Holt, CDVC did not repeat the information she presented last winter when she presented this program as a stand alone event, but also included a wider scope of information for just about any therapist. Not only did this workshop confront many myths that we hold, even as identified gay and lesbian psychotherapists, but explained how we are in a unique position, because of our place in the community, to educate and prevent further instances of domestic violence.

Affecting as many as one-third same gender couples, it requires that we understand the unique dynamics of gay and lesbian battering. The interventions offered and social services that are in place in the Los Angeles area help the clinician to provide the necessary assistance to those persons identified as being victims of abuse.

Holt, who is the domestic violence director at the Gay and Lesbian Center, has spoken extensively about this issue to many professional populations, and we were fortunate to have her at the conference, as the number in attendance suggested that she provided a most well sought after presentation, and the reviews shared the theme of wanting to know more about this subject and to extend this discussion, which was so wonerfully presented.

In the workshop, Harm Reduction and Beyond, Rob Weiss, LCSW, and Anthony Zimbardi, PsyD, MFT took the participants through the discussion of how this model of therapeutic intervention began, how is it most appropriately employed, and what it has the opportunity to provide in other areas of treatment. This discussion has been debated for some time, and this program was not only a survey course, and also brought the seminal elements of the debate to the forefront, so as to bring the participants into a well rounded discussion.

In this workshop, the principles of harm reduction were discussed, such as abstinence from drugs should not be the only goal of the program designed, that it is neutral regarding long term treatment goals, and that drug use is a fact of life. It presented the adage that "Dead addicts don’t recover." Throughout this program, questions surrounding this model surfaced, such as, "Can we, as professionals, be both faithful to the standards of our profession and still be helpful to the drug user who is our client, and refuses to stop using?" The answer is a resounding "yes." Weiss provided an opportunity to see how this model can be expanded to include other addicts, such as sexual, gambling, eating, and others.

Though not exhaustive, harm reduction does have helpful applications to those in the primary stages o recovery. Of course, the first step is to have the client take an assessment of their situation and eventually formulate this assessment into long term and short term goals for their lifestyle. The evaluations from this course indicate that the discussion needs to continue, and that this forum served as a wonderful start to a rich exploration of harm reduction.

The brunch and keynote address provided some interesting turn of events, as after the address made by the Co-Presidents, Stuart Altschuler, MFT and , LCSW, it was announced that the featured keynote speaker, Don Kilhefner, PhD, was unable to attend and address the assembled due to illness. Lillene Fifield, LCSW, a long time friend of Kilhefner’s and Co-Chairperson of the conference, did a marvelous job sharing with the assembled the effects that Kilhefner’s presence and activism in the community has had. He has not only been a direct servant-leader of the community, and has furthered a clearer understanding of gay and lesbian psychology within the psychoanalytic community and psychotherapeutic profession as well, but has also made it possible for us to gather together at conferences such as this. "It is a shame that this hero of ours cannot be here with us, but in many ways, because of what he has done over the years, he is very much with us" Fifield stated, capturing the mainstream of her discussion of the man and activist.

The workshop, Psychopharmacology for Persons with HIV, with Joel Miller, MD and Karen Sandler, DO brought an erudite discussion of the various complex needs that persons with HIV encounter when also seeking to include psychotropic medications into their regimen. Many psychotherapists tend to not broach the topic with their clients as they feel that they are already taking too many medications, and so they have a basic therapeutic need unmet. As Miller and Sandler discussed, this doesn’t need to be, as there are some key concepts, that when employed can help the HIV positive person incorporate the psychotropic medication into their program, without jeopardizing the integrity of their program.

Sharing cases from their individual practice, they detailed the various medications available, and indicators that are important, given the added HIV status. Miller, a recent graduate in psychoanalysis also shared how many patients he encounters are shy to discuss psychotropic medications or have been so drilled that to do so would be dangerous or unwise, requires an extra degree of care. This may include the full ramifications of medication usage as well as hopes and treatment goals for such a course. Overall, it requires an open, listening therapist, who knows how to integrate meds.

Another intimate workshop, Dual Diagnosis: Substance Misuse and Other Psychiatric Disorders, with Neva Chauppette, PsyD, offered the opportunity to see how psychiatric disorders can be masked over by a preeminent substance abuse disorder, therefore causing it to go untreated. Treatment strategies were discussed, especially as the related stories of clinicians entered the forum, opening up an opportunity to share what has worked and what hasn’t, and to identify red flags that may suggest further exploration as to what is at the root of the person’s situation.

This year, in addition to the membership forum, we were able to offer a student forum, with the discussion of the paper authored by two recent graduates from the California School of Professional Psychology, Teresa Foley, PsyD, and Karen L. Takei-Kobayashi, PsyD. This allowed for students to gain a wider perspective how to better approach their personal care and exploration during their graduate program and to manage the information that they integrate. Also, they learned about the service that LAGPA has in reaching out to students, and helping them to not only navigate their academic careers, but to also begin an internship, or locate a mentor who can help them develop an advantage in engaging the profession.

This conference had many firsts, and the expansion was the primary learning method. As we prepare for the Seventh Annual Conference, many lessons from this year will be taken into strong consideration, and we are sure to provide a conference that not only rivals that of other organizations, but will help to develop upon the hopes and expectations brought about by this year’s event. Your participation and responses, through conversation and evaluations, have made it possible for us to see how this worked and what needs improvement. It was a team effort of all members attending, and that will make all the difference as we continue to reachfor the cutting edge and beyond.

The afternoon workshop, Sex Changes: An Overview on Transsexualism for Psychotherapists, was the most popular choice in the second series of workshops. Now we all know that most of us do not have a single transsexual in our practice and many have never even met a transgendered person, beyond pointing and whispering at one at a parade or club. So what was the attraction? Was it prurient curiosity? A genuine desire to learn more about a new area of practice? Or maybe, it was a safe way to explore/wonder about an area that most of us never dare to go, but being gay, lesbian or bisexual, we only skirt around the edges of gender roles, gender appearance and gender identity.

The presenter, Arlen Ring, Ph.D., was knowledgeable and extremely thorough. At first I thought that he was a little dry but he seemed to be aware of this tendency as he lightened up the presentation with slides of photographs, etchings and paintings of famous, infamous and unknown transpeople or those who might have been. Again, there was an element of increased interest in the photos and I caught myself wondering if maybe the presenter was a transgendered person himself. I do not usually speculate on the gender of people I meet but perhaps that is because that question is usually clear, at least on the surface. I have also lived in Hawaii where it is certainly more common to see mahus, men raised as women, interwoven in the culture. Does that sound like, "some of my best friends are..?." Well, I cannot say that because for full disclosure, I have to admit that to my knowledge, I do not have any friends who are transgendered.

I raise the point for several reasons. Dr. Ring explained that our first reaction when we meet people, is to assign gender. We are uncomfortable until we do so. With transgendered people, those determinations are harder to make and as Dr. Ring pointed out, some transpeople intentionally like it that way. I wonder that if the urge to categorize is actually beyond our conscious control and goes back to our primal cave days when life depended on quick judgements of safe or unsafe, food or not food, enemy or mate, how can we sort out our own motivations or interest in this topic as members of a workshop or as therapists working with trans clients. Yet, I also need to take some responsibility and admit that as someone who does not define themselves as gay or straight, but rather bisexual, I am interested in the experience of others who cross the gender boundary, either partially or completely. While I eschew the philosophy of an either/or dichotomy and embrace one of "both/and," trans people have taken that philosophy and practice to a much higher level. There are elements of the gay and lesbian movement that have said that transgendered people do not belong in the movement because their issue is one of gender and not sexuality, yet the truth is never so clear cut.

The recent LA Times Magazine cover story on the transgendered girlfriend of a military serviceman who was murdered because he was "gay" illustrates the complexity of the situation.

All of this is a digression but a necessary one. As Dr. Ring also demonstrated, because the knowledge level of most of us is so low, it is necessary to go back to basics. He explained terms, reviewed diagnostic criteria, etiological factors, treatment issues and more.

On the clinical side, he offered his usage of the term, "atypical gender development" as the one most accurate, and I personally think, more respectful compared to some current diagnostic usages.

When interacting with a transperson, use the pronoun they appear to be or simply ask them how they would like to be addressed. Confusing to us hard core queer folk who can tell right away with our super gaydar, top or bottom, butch or fem, he made the point that one cannot tell what the sexual object will be from the person’s gender.

In a similar way that some gays and lesbians reject bisexuals, you are either one of us or not/with us or against us, transgendered people are rejected because they too cannot be easily categorized or refuse to be. Are you gay if you are a "post transition nonoperative transsexual woman in a sexual relationship with a male? The public sees a heterosexual couple, yet in the bedroom the genitals match."

People who are moving where they stand on the gender continuum are transcending binary thinking. Most gays and lesbians are like the rest of the straight world; they use binary thinking. Using this type of thinking, at the most basic level, transgendered and transsexual people scare them.

Have we all come to this workshop to assuage our fears in some way? Dr. Ring offered that he long ago gave up the search for the "true transsexual." The Los Angeles Gender Center where he works, deals with people who have had surgery or are planning to, those who take hormones and those who do not, those who dress as a different sex, those who want to be in therapy to talk about gender issues and all combinations of these options as people stop, start and move back and forth along the gender continuum. He explained that the Center helps people examine their choices and the consequences of where they are and where they may choose to be.

From a question in the audience, Dr. Ring provided some guidelines for parents who may be concerned about the gender identity and/or the sexual orientation of their children. Tell them that it is not their external influence that caused the behavior. Parents should try not to act out of their own shame. Let children do what they will but make them aware of the consequences of their choices and actions.

Dr. Ring also provided some technical information on the Standards of Care for Gender Identity Disorders, included a gender identity reading list in his handouts, talked about intersexed conditions, discussed co-morbidity issues with other disorders and the need for careful understanding and diagnosis, entertained a brief exchange with the audience on the issue of de-pathologizing GID, balanced with the economic issue that insurance pays for pathology and surgery is expensive, and he still did not finish all of his planned presentation.

Overall, I thought that the workshop was excellent. I still wonder what brought all those people together to hear about this topic. I would have liked to hear more about why they were there, but, of course, that would take up a whole, additional workshop. For me it was educational, informative and thought provoking. Is that too dry? How about fascinating and possibly erotic? Now you wish that you, too, had chosen Door Number Three.

On a more thoughtful note, it provided a space to think about ideas that I do not usually reflect on. What does my own gender identity look like? What about my gender expression (the communication of gender)? Do they match or not and what would it be like to shift things around? Then I throw in sexual orientation and erotic response and my head begins to spin.

On another avenue, I wonder what the trans folk in the audience thought of the discussion. As much as I have heard complaints that there are not enough women in LAGPA, there are other groups and ethnicities with even smaller representation. This absence is LAGPA’s loss. This year LAGPA’s bylaws were revised to include more inclusive language, specifically adding "bisexual" and "transgendered" in many places where it had been absent. This workshop was another step in developing LAGPA’s inclusiveness and educating its members.

Regardless of why they came, I hope that my colleagues who attended the workshop got as much out of it as I did. If the size of the workshop and the reluctance of people to leave were any indication, they did and Dr. Ring and his presentation were a resounding success. If you agreed, disagreed, loved, liked or were horribly offended by this review, please do let me know and the editors and I will be happy to dialogue with you and include your views in future editions of our publications.

The morning seminar, From a Cultural Lens: The Journey of Being A Person of Color Working with Lesbian, Gay, and/or Bisexual Clients, was actually an intimate workshop that engaged both the presenters and the audience. While there were no Pacific Islanders present, we were in effect, engaging in what Hawaiian culture calls "talk story."

As each participant came into the room, we were given a name tag and asked to describe aspects of our diversity which were then shared around the room. The moderators, Carmen Navarro, MSW and Mike Foster, LCSW and the panelists, Hasani Gough, LCSW, Salman Husainy, MSW, Gina Marie Ong, MFT, Esq and a late addition, Kira A. came from diverse backgrounds, African American, Chinese, Armenian, Pakistani and more but also shared a number of commonalities such as being writers, having shared experiences of oppression and having become outspoken role models.

We started by briefly looking at what culture meant to each individual. The responses included, "Flavors, differences, a way of living that’s integrated with the person." "The environment of ideas, assumptions, social organizations that surround us and inhabit our psyche." Also, there was the simple but encompassing, "The Lens through which I understand myself and the world."

Through the panelists’ experiences, concrete facts of different cultures were shared, such as some Asian American clients being more results oriented and less process focused. Or, some Latino culture using silence as the only way to deal with queer sexuality. In Pakistan, it was explained that there are homosexual acts but no homosexual orientation. As the punishment for these acts, based on the Koran, is death, it is understandably difficult to develop a healthy same sex orientation.

The workshop also explored the theme of culture and developing identities as an ongoing process and as one that occurs on multiple levels. Different identities come to the surface in different settings. Ethnic culture, queer culture, linguistic culture or social class may shift as the salient variable in any interaction. In working with clients, determining whether to place any one of them in the foreground or background depends on what is in the best interests/welfare of the client.

Related to this, panelists stressed the need to process ones own issues first, so these do not get in the way of the work with clients. Despite an outward similarity of culture, the therapist cannot assume that they know that client’s experience until the client begins to reveal his or herself.

There were of course handouts with definitions, charts of comparisons of cultural values in different cultures, and even pointers for practitioners. Yet, while I am sure that these will be valuable in the future, they were not examined in the actual workshop as there was not enough time to get to them. More importantly, there was a desire by both participants and panelists to focus on sharing personal experiences and the learnings that had been taken from them. The questions and discussion was lively throughout and overflowed past the allotted time. The workshop participants did not want to leave and left only reluctantly. However, I believe that they left as I did with new thoughts, reflections and an excitement to get back to the work of culture and psychotherapy.