COUNSELING APPROACHES AND RELATED ISSUES IN SEXUAL RELATIONSHIPS

Rafidah Aga Mohd Jaladin

Abstrak

Secara khususnya artikel ini berfokus kepada hubungan homoseksual di kalangan wanita,
iaitu lesbianisme. Masalah golongan minoriti lesbian memang sukar difahami kerana lesbian
merupakan 'golongan yang tidak diiktiraf' di negara kita. Namun, untuk menjadi seorang
kaunselor yang berkesan, perlu ada persediaan diri dan kelayakan profesional yang
mencukupi untuk memberi khidmat kaunseling kepada mereka yang memerlukan.
Masalahnya tidak ramai yang tahu latar belakang kehidupan lesbian dan bentuk
permasalahan yang dihadapi oleh golongan ini. Kertas ini cuba memberi pendedahan tentang
kehidupan dan latar belakang lesbian di dalam masyarakat kita. Tumpuan utama akan
diberikan kepada pendekatan yang boleh digunapakai untuk memberikan khidmat kaunseling
kepada golongan lesbian. Isu yang berkaitan dengan etika dan nilai masyarakat dalam
membantu klien lesbian turut dibincangkan.

Introduction

In the Malaysian context, it is generally unknown how much people know about lesbianism
and to what extent they would accept the lesbians' existence and their unique lifestyle. It is
undeniable that an abundance of information about lesbianism exists on the internet, in
newspapers, magazines, films, novels, books, and other sources. However, we do not know
whether this information is meaningful to Malaysian people. Being in a Muslim majority
country with strong traditional values, most Malaysians tend to view lesbianism as a
disgraceful and shameful act. Malaysian society in general also rejects homosexuality.

The phenomenon of lesbianism can be detected if one truly pays attention to the "hidden"
issues normally discussed in newspapers or magazines. The most frequently sought-after
columns that lesbians use as a medium of expression are "Bisikan Rasa", "Nostalgia",
"Nukilan Rasa" and the like. Lesbianism has been known and practised secretly among a
minority of female students at boarding schools (especially at segregated schools), and
among artists, police and army officers, and even among professionals and intellectuals. How
to understand lesbianism in the Malaysian context and how to deal with the lesbian
community are the major concerns of people in the helping profession. It is also the focus of
this paper.

This paper is aimed at describing lesbianism with special focus on the various approaches for
counseling lesbian clients. Some ethical and value issues in counseling lesbian clients are
also discussed to help counselors and counselor trainees to be aware of, and predict, the
potential problems.

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Definition and Female Sexual Identity Problems

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies lesbians and
gays in Group A referring to sexual disorders due to sexual identity problems. According to
Dr. Mat Saat Bald (in Rozienah Husain, 1988), sexual identity disorders can be classified
into three different types: Transverse-Style, Transsexual, and Homosexual. Transverse-style
refers to women who like to dress and act like men but have no intention of changing their
sexual organs. This group of women is also sexually interested in men. They are also known
as heterosexuals or bisexuals or locally known as bapok, mak nyah or pondan (Mohd Tajudin
& Mohamed Mansor Abdullah, 2001). Transsexuals, on the other hand, are women who feel
like men and want to change their sexual organs in order to feel complete (Meriam Omar
Din, 2001). However, they may also be women who are very proud of acting and feeling like
men without a need to change their sexual organs (Rozienah Husain, 1988).

The homosexual type refers to women who have sexual relationships with other women.
They differ from the first two categories because they are only interested in women
(physically and sexually). They may act like ordinary women but their object of desire is
another woman. They accept themselves as women and do not want to be associated as men
(King & Bartlett, 1999). Lesbians fall under this category of gender identity disorder. An
interview with a registered counselor (Hushim Salleh, 2002) in Malaysia was conducted and
it was hypothesized that the roots of lesbianism are two-fold: (1) these women have gender
identity crisis and seem to not know themselves completely. They may know they are
females but they do not understand their sexual desires; and (2) they have gender disorder
because they are attracted to females only in terms of obtaining love, sexual satisfaction, and
in expressing their feelings.

Types of Female Homosexual

In Malaysia, there are six types of female homosexual behavior that counselors or counselor
trainees should be aware of (Rozienah Husain, 1988). These are:

1. Obvious lesbianism - refers to women who portray themselves as lesbians without

shame, worry, or fear; in fact, they are proud of their lesbian lifestyle.

2. Addicted lesbianism - refers to women who are in great need of finding another
woman to sleep with.

3. Secretive lesbianism - refers to women who secretly practise lesbian actrvitres.

Sometimes, married lesbian women carry out lesbian activities without their
husbands' knowledge. Only those very close to the women know about their hidden
agenda.

4. Adaptive lesbianism - refers to women who accept themselves as lesbians and live
like lesbians and who can easily adjust themselves to their environment.

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 5. Seasonal lesbianism - refers to women who seek female partners while at college or
when there are no men around. About 10% of them will remain as lesbians after
school or college life, and about 90% will behave like ordinary women and have
relationships with men.
6. Prostitute lesbianism - refers to women who have sex with other women as a means
of getting money. This is the type of lesbian that can be bought when needed.

Lesbian Lifestyle

Lesbian couples behave like spouses in a house, but they behave like normal women outside.
In Malaysia, the lesbian lifestyle is very difficult to detect compared to gays' because lesbians
are perceived as normal women living together as housemates and their relationship, even
though sexual in nature, is perceived as best friends. Lesbians in the relationship have their
own social roles. One will take the "masculine" role and the other will take the "feminine"
role. Sex roles are played accordingly and interchangeably. Their sexual relationship does not
involve usage of artificial penis or other sexual gadgets because most lesbians confess that
orgasm with female partners is much more satisfying than with male partners (Rozienah
Husain, 1988).

Lesbians' lives are established by their stance and this can be classified into two types: ego-
syntonic or ego-dystonic lesbianism. The ego-syntonic lesbian feels comfortable with her life
as a lesbian; she does not worry about being lesbian and happily accepts herself and enjoys
her life as a lesbian. On the other hand, the ego-dystonic lesbian is sexually attracted to
another woman but at the same time feels guilty about it. Due to this guilt, she views herself
as abnormal and is always in a state of fear. She feels forced to act and behave like a lesbian
because of her sexual instinct. Most lesbian clients in Malaysia have the egodystonic stance.

Contributing Factors in Lesbianism

According to Mat Saat Baki (Rozienah Husain, 1988) and other experts in the area (Meriam
Omar Din, 2001; Noriah Ishak, 2001), there are five factors that contribute to lesbianism.
First is the woman's childhood experience. A child's first contact and interaction is with
parents, and this relationship will determine the child's identity and social interaction in later
years. If parents encourage the child (intentionally or unintentionally) to behave
inconsistently with her gender, for example cross-dressing, the child might use this
experience to guide her future actions.

Second is the woman's sexual experience (Diamant, 1999). Those women who have had
experience of sex with both male and female can develop a personal preference for the better
partner. If the woman found her female partner more sexually satisfying, she may no longer
want to have sex with a man. Sometimes this applies to the woman's first sexual experience.
If the first was with a female partner, then there is a possibility that it will continue. Or if the
first was with a man and it was a bad experience, the woman might tum to another woman
for sex.

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Third is the woman's hormonal regulation. Some women have less female hormones (e.g.
estrogen) but more male hormones (testosterone) and this causes the female to act like a man.
Fourth is the experimental experience of the woman, for example, if a woman experimented
having same-sex sexual experience, and she liked it a lot, she might continue doing it.

The last factor is the woman's traumatic experience during childhood or adolescence. If a
woman was raped by her father, brother or other male family member, she may generalize
her hatred and hate not only them but the rest of the male population. Counselors or other
professionals should be cautioned that if a woman experiences any of the abovementioned
factors, it means that she has an inclination towards lesbianism. However, she cannot be
labeled as a lesbian until the woman admitted it herself (Mat Saat Baki in Rozienah Husain,
1988).

Other contributory factors, according to Hushim Salleh (2002), are early exposure to
socialization (coming from a female dominated family or attending girls' boarding schools),
and influence of parenting style (e.g. having autocratic parents who restrict their daughters'
socialization with male friends).

Counseling Lesbian Clients from Several Approaches

In the Malaysian Counseling Association (PERKAMA) 10th Convention held on 12-13 May
2001 at the Academy of Islamic Studies, University of Malaya, Malaysian counselors and
psychiatrists presented several approaches in counseling clients with sexual identity problems
such as lesbians. The convention theme was "Managing Gender Identity Problems:
Collective Responsibility". Four approaches are relevant to the topic of interest: the
traditional approach; the non-traditional approach; object-relation therapy; and the Islamic
approach. The following section shall discuss the gist of these approaches.

The Traditional Approach

Psychiatrists normally use this approach because it is heavily based on the medical model
where symptoms are the main indicators of the client's problem. The main reference in
counseling a lesbian client is the DSM-IV because this manual classifies all the symptoms a
client may portray into five axes: Axis I (clinical disorders or other conditions that may be a
focus of clinical attention), Axis II (personality disorders or mental retardation), Axis III
(general medical conditions), Axis IV (psychosocial and environmental problems), and Axis
V (global assessment of functioning). Each axis explains the type of disorder or mental
illness experienced by patients or clients in the hospital or counseling setting (Mohd Tajudin
& Mohamed Mansor, 2001). Lesbians and gays fall under the category of gender identity
disorder.

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The Non-traditional Approach

Counselors and psychologists who use the DSM-IV manual as reference normally use this
approach. They use the manual as reference in addition to the humanistic approach in their
counseling process (Mohd Tajudin & Mohamed Mansor, 2001). This is different from the
traditional approach used by most psychiatrists because the non-traditional approach does not
totally rely on the manual to identify the client's problem. The non-traditional approach
discusses the client's case based on the following five factors:

a. life stage developmental approach;

b. cross-cultural approach;

c. gender role analysis;

d. ecological analysis, and

e. trauma analysis

Mohd Tajudin and Mohamed Mansor (2001) suggested that all these factors can give holistic
information on the nature of the client's problem.

Hushim Salleh (2002) reported that lesbian clients he helped had problems with their sexual
orientation. Thus, the counseling process will start with rapport in order to establish truce
before focusing on the exploration stage. This exploration stage is crucial because the clients
will disclose their history: when, where, how and why they were involved in lesbianism.
Then comes the problem identification stage, followed by generation of alternatives. In the
next stage, both counselor and client would discuss the pros and cons of each alternative so
that the client can take appropriate action. If the problems are based on the client's sexual
orientation, then the best theory to use is Rational Emotive Theory (Hushim Salleh, 2002).

However, Meriam Omar Din (2001) suggested a typical Person-Centered Counseling (PCC),
founded by Rogers. This approach has five requirements: (1) accepting and being accepted;
(2) building the clients' trust; (3) encouraging clients to share their subjective experience; (4)
detecting clients' awareness in terms of the changes that happened to them. The changes are
observed in terms of their coping mechanism, physical appearance, beliefs, thoughts, locus of
evaluation, and communication skills. If counselors are aware of these small changes, they
can encourage and help the lesbian clients to make bigger changes in their lives. The final
stage would be (5) helping clients to tackle "here-and-now" problems in a continuous manner
so that they understand the actual problem. Counselors can thus prevent clients from
committing further self-destructive behaviors that invite permanent consequences.

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Object-Relation Therapy

Object-relation therapy differs from other therapies in terms of understanding the clients'
issues and problems. It takes into account the self, the significant others, and how these two
interact. This interaction brings a unique meaning to the person experiencing it and can only
be explained by the person. Thus, an object-relation therapist must focus on the theme of the
story presented by clients in the counseling session because this theme has its own unique
meaning from the clients' perspective. Specifically, this approach is used to explore the
clients' internal psychological process that refers to their life meanings. The therapy assumes
that each meaning assigned to life episodes is due to the individual's interaction with others.
This interaction influences and shapes her external and internal life. The therapy also
assumes that the individual's meaning of life indicates the individual herself.

The therapy uses specific concepts such as the third reality (referring to the client-counselor
relationship), working models (referring to an individual's cognitive schema), attachment
(referring to early childhood attachment and adult attachment), and holding environment
(referring to the way the counselor should treat the client, i.e. "seperti menatang minyak yang
penuh" (Noriah Ishak, 2001, p.IOl). The counseling process has three stages: initial, middle
and final therapy. The initial therapy focuses on creating a conducive environment, building
trust, understanding, and learning about the client. The middle therapy is about helping the
client gradually see, tolerate, understand, challenge, and then reconstruct and change old
meanings about oneself to others, and oneself to herself. The final therapy is where the
counselor encourages the client to understand the new internal working model and to use the
model as a guide to change. Sometimes, the counselor may say "it is okay to be the new you,
while remembering the old self' (Noriah Ishak, 2001, p. 11).

The Islamic Perspective

Islam does not allow lesbianism in Muslim society because "Allah the Almighty condemns
those men who appear like women and those women who appear like men" (Asmungi Sidek,
2001, p.?). Thus, counseling a lesbian client using the Islamic perspective may cause some
difficulties because of the conflict between Islamic teachings and lesbianism. However, if the
lesbian client would like to change her sexual orientation because of guilt feelings, this
approach may be of help because the goal of the client and the counseling process would
coincide.

Norazman Amat (2001) presented 11 steps of the Islamic counseling process as guidelines
for Muslim counselors: (1) set proper goal, (2) say prayers to Allah, (3) establish therapeutic
counseling relationship with client, (4) assist the client in exploring herself, (5) express
understanding and empathy, (6) guide the client's exploration and help her to understand, (7)
identify the client's needs, (8) help the client to set goals, explore alternatives, and plan
strategy, (9) encourage the client to act and bertawakkal (have absolute trust in Allah), (10)
help the client to gain insight into her problem, and (11) end the counseling process once the
client is ready to act and change.

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Ethical and Value Issues in Counseling Lesbian Clients

Lesbians are a minority group and working with them is challenging especially to those with
restrictive attitudes and values towards homosexuals (Peterson, 1970). Counselors who have
negative reactions to homosexuals have to be careful not to impose their own values on their
clients because they are bound by ethical and moral obligations. The ethical codes of the
American Counseling Association (ACA), the American Psychological Association (APA),
and the National Association of Social Workers (NASW) clearly state that discrimination on
the basis of minority status - be it race, ethnicity, gender, or sexual orientation - is unethical
and unacceptable (Corey et al., 1998). Thus, counselors need to have sufficient knowledge
and skills to provide sensitive treatment to lesbians.

Corey et al. (1998) commented, "Unless counselors become conscious of their own faulty
assumptions and homophobia, they may project their misconceptions and their fears onto
their clients. Therapists must confront their personal prejudices, myths, fears, and stereotypes
regarding sexual orientation" (p.lOO). In addition, Weinstein and Rosen (1988) contended
that when a person comes in for counseling and states that she is a "homosexual", it is
important to explore and understand what is meant by that declaration. Is the client
expressing a feeling? Is the declaration based on experiential factors? Is it based on fear? All
are possible because lesbians have had different life experiences. Counselors should not take
such labels at face value and at the same time should not negate their possible validity.

Besides ethical issues, value issues also arise in counseling lesbians. A number of special
situations are likely to produce "a crisis" or need for counseling (Weinstein & Rosen, 1988),
for example, facing discrimination, prejudice, and oppression in a society, workforce or
relationship. Weinstein and Rosen (1988) identified four special situations in counseling
lesbians. The first involves the decision to "come out". In most cases, lesbians often bring to
counseling the struggle between concealing their identity and "coming out" (Taylor, 1999).
Coming out refers to sharing one's identity with others such as parents, friends, spouse,
children, employer or anyone. Secondly, the confidentiality in dealing explicitly with the
clients may cause some problems because laws in the various states differ with respect to the
confidentiality of professional records. Thirdly, the problems of loneliness and grief are
common among lesbians. Lesbians are known for their desire for a long-term relationship
and sometimes this ends up in anguish over the dissolution of a relationship. These problems
are not unique to homosexuals, but they are exacerbated by the lack of societal support.
Lastly, lesbians may have problems with sex-related diseases such as AIDS and genital
human papillomavirus infection in women who have sex with women (Marrazzo, 2000).
With the reality of these diseases, lesbians often face the loss of friends or partners, the lack
of support for grieving, and also the fear of infection.

Counseling lesbian clients may become more challenging when it involves value conflict
between religion and homosexuality issues. Corey et al. (1998) cautioned all counselors to be
aware of the conflict between religion and homosexuality because it may pose problems for
both clients and counselors. A client's religious values can be a source of conflict to a person
who is struggling with sexual identity issues. At the same time, the religious and

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moral values of counselors can also pose problems in maintaining objectivity when working
with clients who want to explore their sexual feelings, attitudes, and behaviors. In view of
this conflict, many writers have voiced their concern: Is it ethical to counsel lesbian clients
without having received specialized training with this population?

Implications for Counselors

Researchers have given many recommendations to address the issues in counseling lesbian
clients. Most proposed quite similar strategies, such as to first critically examine any myths
and misconceptions they hold about lesbians, and then to obtain specialized training in
working with lesbian clients. Specifically, they proposed the following guidelines when
counseling lesbian clients: (1) to change counselors' attitudes toward lesbians; (2) to acquire
a body of knowledge about community resources for these clients; (3) to confront counselors'
personal prejudices, myths, fears, and stereotypes regarding sexual orientation (Weeks,
1985); (4) to acquire specialized knowledge about the lesbian population in general and
about the meaning of a lesbian identity to particular individuals (Schneider & Tremble,
1986); and (5) to continue educating themselves about lesbian identity development and
management (Eliason, 1996).

These guidelines are consistent with the goal of helping the lesbian client advocated by most
mental health professionals, that is, to accept her sexual orientation and to cope with the
possibility of stigmatization (Schneider & Tremble, 1986). Most experts in this field suggest
that counselors increase their awareness of ethical and therapeutic considerations in working
with lesbian clients by taking advantage of continuing education workshops sponsored by
national, regional, state, and local professional organizations (Corey et al., 1998; Weinstein
& Rosen, 1988; Schneider & Tremble, 1986). Studies have shown that workshops developed
to enhance expertise of service providers who work with lesbian clients are proven effective.
Their benefit is not just in helping lesbian clients but they also contribute to changing
society's stereotypes and prejudices toward this minority population so that lesbians get
societal support when needed.

Conclusion

To understand lesbianism in a society that prohibits the practice of lesbianism is not an easy
task because of the many value issues and conflicts a counselor has to consider. However,
there are ways to prepare ourselves for helping a lesbian client such as by fully understanding
the code of ethics, always consulting other experienced experts, and following the counseling
association guidelines. We cannot always be the best in helping others but we can always try
the best possible way to help them as long as we adhere to ethical guidelines.

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