Week 11 Project

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“Virtual Field Experience™: Affirmative Therapy” Program Transcript

DR. NINA NABORS: Hi, I'm Dr. Nina Nabors. This week you're going to watch a video program of a simulated therapy session that illustrates affirmative psychotherapy with a lesbian client. I'm going to be interacting with Dr. Constance Patterson, who's the therapist illustrating this session. Let's watch.

So Dr. Patterson, if you could start us off by telling us just a little bit about affirmative therapy with an LGB client. And then set the scene for us.

DR. CONSTANCE KINDRICK PATTERSON: Affirmative therapy is really based in the notion that much of the difficulty in working through issues of sexuality are based in growing up and learning in contexts that are quite discriminatory and quite biased. And so people internalize very negative concepts of homosexuality. In this case, the client has grown up in a very conservative home with very conservative values and now is grappling with issues of whether or not she's a lesbian. And this is a very difficult thing at 39. So that's the situation for her.

The question is really about helping her come to terms with the questioning and deciding if and how to come out to the world as a lesbian.

DR. NINA NABORS: OK. And what should we be looking for, then, as we watch the session?

DR. CONSTANCE KINDRICK PATTERSON: With a client who has this conservative background, what I'm going to be showing you is inviting her to think about what this might be like. What might be some of the consequences if she should decide to talk with her parents, if she should decide to reveal to them what she's thinking is true for her.

And she has had these issues start up for her because she now has a colleague at work who is living openly as a lesbian, and including having her in her home for dinner party, has modeled a pretty happy lifestyle. And so she, I think, is beginning to see her possibilities in vicariously hearing about and seeing this other person's life.

DR. NINA NABORS: OK, great. Well let's watch it.

DR. CONSTANCE KINDRICK PATTERSON: Well, Tracy it's really interesting that your mother's decided to talk about a your starting a family right now.

TRACY: Yeah. You know, she's been generally pretty good about it. And she hasn't said anything. And I don't think she would be really blunt or obvious about it.

But you know, I was there a couple of nights ago at my parents' house for dinner. And my brother was there with his kids and his wife. And issue came up about whether or not they were going to have another kid.

And my mother made a joke about my not having a child yet and hinting around. I'm 39, getting older. And at what point was I going to start thinking about children.

And in light of everything that I think I've been going through and trying to figure things out, it just felt like-- maybe I was reading too much into it. But I just ended up thinking about it a lot that night. And I didn't really know how to respond when I was at the dinner table. And they kind of laughed. And I sort of laughed and went along with it.

But it was hurtful because I just don't know what to say to her. I don't know what to say to my husband about this because he hasn't brought it up, really. I don't know. I think it's just the timing seems-- well, I guess the timing never would be good.

DR. CONSTANCE KINDRICK PATTERSON: The timing would never be good?

TRACY: Well, to bring it up. For my mother to start bringing it up. But it just seems odd that she's bringing up the issue of children now, when it feels like I have so much doubt about whether or not I want to stay-- even saying whether or not I want to stay in this marriage.

DR. CONSTANCE KINDRICK PATTERSON: I'm about to ask her she's anticipated being a parent because it's more, in some ways, a safer role to think about something that's outside of what she's already established in her life as the good daughter in a very conservative household growing up in a very conservative environment. This is a new possibility for her. And I want to see how she's thinking about that.

DR. NINA NABORS: This being a parent.

DR. CONSTANCE KINDRICK PATTERSON: Being a parent is a new possibility for her.

DR. NINA NABORS: OK.

DR. CONSTANCE KINDRICK PATTERSON: And nobody has any idea about that except, you're still struggling with that on your own.

TRACY: Yeah. You know, Mike and I talked about our relationship in pretty vague terms. I think if we were business partners, it would be great.

We get along. And I have so much respect for him. And he's a good person. And he's got a good job and enjoys what he does. And we can talk. Looking outwardly in at our relationship, you would think wow, this is a solid relationship.

DR. CONSTANCE KINDRICK PATTERSON: It's a caring and loving relationship.

TRACY: Yeah. But it just doesn't feel like what it should be.

DR. CONSTANCE KINDRICK PATTERSON: OK. Let's go back just for a minute to the issue of children. Do you think you want to be a parent?

TRACY: You know, if you'd asked me any time up until the last month, maybe I would've said no, that I was happy being an aunt, and that I was more interested in my work, and that I hadn't had much experience. You know, I have a younger brother a couple years younger than me. But aside from that, I hadn't spent much time around kids.

And I think I've told you I went to that dinner party at the coworker's. And there was a couple there, two women who were together. And they had a child-- not at the dinner party, but they had talked about a child that they had. One woman had had it from a previous relationship.

And I guess it was the first time it even really occurred to me that that could work, that that could be how that would-- it sounds so-- the way I'm describing it isn't very good. But I guess I started to rethink how that might be possible.

DR. CONSTANCE KINDRICK PATTERSON: Two women could have a child, establish a family together?

TRACY: Right. And I logically know that it could happen. But I guess just seeing it, seeing a couple that seemed to be happy and stable, and had looked like they were providing, from what they described, a good home for this child. And I think that stirred up some feelings that I hadn't really thought about before.

And maybe where I'd always discounted that I didn't want children, maybe it just didn't fit into this picture that I had of how I would live my life in this marriage. And it just started getting really jumbled.

DR. CONSTANCE KINDRICK PATTERSON: OK. So it really broadened your perspective on what families might look like, to hear these two women talking about their family, and makes things a little more complicated for you as you think about perhaps becoming a parent.

TRACY: Yeah.

DR. NINA NABORS: So a couple of times now I've noticed that you rephrase the words, reframe the words that she's speaking. What's the purpose there when you do that?

DR. CONSTANCE KINDRICK PATTERSON: Well in many ways, I'm laying groundwork. I think that she's very, very tentative about labeling any of her ideas or feelings. At some point, I will start talking about lesbian families. At some point I will invite her to think about and put the concepts together differently. And so as I rephrase some of that, I'm laying groundwork for labeling some things differently as we go along.

DR. NINA NABORS: What do you think that does for the client when you reframe like that?

DR. CONSTANCE KINDRICK PATTERSON: Well she's been tentative about saying many, many things. She's just very cautious, very hesitant as she phrases things. And I think the invitation is to use more words, to say some things a little differently.

DR. NINA NABORS: Maybe even give her a permission to talk about some of these things more directly.

TRACY: Yeah. Because I think I just put it out of my mind. And this, again, started to stir things up.

DR. CONSTANCE KINDRICK PATTERSON: So mom dropped the question. And now you're thinking differently about some of this. It also sounds like you've had a lot of pressure internally about making some decisions.

TRACY: Yeah, because I'm getting older. And if I want to have a child, which I guess-- I mean I haven't thought about it enough to start talking with anybody about it. But it would be nice to be able to have a child. And I'm getting to the age now where I would need to be getting on with it pretty soon.

And if I were to have a child in my marriage, then I start to worry about, again-- it makes it feel like it's cementing it more and that it's committing me in a way. I mean, I'm married. I should be committed. But it feels like it just commits me in a way that I'm not committed right now, I guess. And that's--

DR. CONSTANCE KINDRICK PATTERSON: Well, as I'm hearing the way you're talking about this, it's clear that the way that you've always thought about the world, the way that you expect yourself to feel committed in this relationship is really at question right now. And you don't need to be making any decisions today or next week or whatever. But certainly looking at the broader picture, your confusion, your unhappiness, those decisions are going to have to come.

TRACY: Yeah. Because if I start to play that scenario out and think about a couple of years down the road, if I were to leave my marriage and get into a relationship and have a child, I can't even imagine that world fitting with my parents' and my brother's. And imagining everybody at dinner would just be-- it just doesn't work.

DR. CONSTANCE KINDRICK PATTERSON: You can't imagine that.

TRACY: No.

DR. CONSTANCE KINDRICK PATTERSON: The question here, in terms of looking at the life as she has expected it to be, and looking at an entirely different framework of her life is something that's very, very difficult for her to imagine. But creating that scenario, and over time creating that scenario over and over and saying how might that be given your expectations, given what you've grown up expecting, would be an important way for her to examine the possibilities of living a different kind of life.

DR. NINA NABORS: It's interesting. And I was actually going to ask you this. As I was watching her affect as she was talking about if she changed her life-- she couldn't imagine it working with her current life-- she was sort of smiling, though. And I'm wondering, does that fit with what she's talking about.

DR. CONSTANCE KINDRICK PATTERSON: Well it's interesting because she's a rather tense person. And she does have some physical illnesses. She has migraines, things that go along with some stress.

You're going to see later on she does something very interesting with her jaw. And it's something about biting. You'll see this later in the session.

But there's some tension there. So perhaps the smiling is breaking the tension for her. It's not as though she's comfortable with the idea.

DR. NINA NABORS: It's almost like a nervous smile. OK.

DR. CONSTANCE KINDRICK PATTERSON: I think so.

TRACY: I mean, maybe they would surprise me, maybe my younger brother but not my parents and not my older brother. They're just pretty conservative. And that doesn't fit for them.

And still, I don't know that it fits for me. I guess it feels like I'm splitting. There's this piece of me that's used to where I thought I was going to be and who I thought I was going to be, and then this whole other stuff that's bubbling up. And it's just, I'm not-- you know, the insomnia is back and I'm getting the headaches again.

DR. CONSTANCE KINDRICK PATTERSON: This dinner party that you went to a couple months ago now really provided a whole different perspective on the world than you've ever considered, at least seriously.

TRACY: Right. Because I could keep it at arm's length. It wasn't-- I almost said a distraction. It just wasn't close enough that I had-- I don't know. It was easier to tuck it away and not have to consider it, mostly.

And now it's not at arm's length anymore. And you know, every time I go into work now, there's Lenore. And she'll bring up her partner, or this friend that was at the party, or this thing that she's doing. And it just--

DR. CONSTANCE KINDRICK PATTERSON: --involves you in a whole different world of possibilities.

TRACY: Yeah. That's pretty uncomfortable.

DR. CONSTANCE KINDRICK PATTERSON: I suspect here that part of what she's experiencing with Lenore talking about her life is that it's more than a sexual attraction. It's a life which has not really presented in its fullest to her before. So the concept of somebody actually living as a lesbian is foreign for her.

DR. NINA NABORS: So it's almost modeling a whole new reality.

DR. CONSTANCE KINDRICK PATTERSON: Right.

TRACY: I'm just not quite sure-- it would be easy if I could just tuck it back and not let it get stirred up. And I think maybe if I were stronger, if I had better conviction, if I used more willpower, or constitution--

DR. CONSTANCE KINDRICK PATTERSON: But I'm hearing some judgment that that's not OK. And you need to put it away. You have to stuff it some place that you can't deal with it. Not going to deal with it, just get it out of sight.

TRACY: It feels hard to do that. It's hard to not hear my father's voice, or my mother's voice, and imagining how they would feel about it. And I guess it's hard to shake that. So I'm not quite sure how I would even do that.

DR. CONSTANCE KINDRICK PATTERSON: So as you think about the possibilities, it's dad's voice, dad's judgment, dad's--

TRACY: Yeah, probably more of that.

DR. CONSTANCE KINDRICK PATTERSON: --concept.

DR. NINA NABORS: Let me just ask for some clarification here, so I'm clear on understanding what the client's saying. So she'd like to stuff the desire to be different.

DR. CONSTANCE KINDRICK PATTERSON: Mm hm.

DR. NINA NABORS: OK.

DR. CONSTANCE KINDRICK PATTERSON: I mean, the father's voice, I think in this case, is really symbolic of all of her socialization. Dad's a retired minister. There's a real heavy, conservative, religious admonition here that that's not OK. And so she's trying to get rid of it. She'd be much more comfortable if she could get it out of her awareness.

DR. NINA NABORS: The desire to be a lesbian, or--

DR. CONSTANCE KINDRICK PATTERSON: Right.

DR. NINA NABORS: OK.

DR. CONSTANCE KINDRICK PATTERSON: And you said maybe your younger brother would be more accepting. Is he the least of the judgmental, different?

TRACY: Yeah, we've always joked he's the black sheep. You know, he left.

DR. CONSTANCE KINDRICK PATTERSON: He's the black sheep?

TRACY: The black sheep in the family. And he left our home-- gosh, he was 17 when he left.

You picked up on something there.

DR. CONSTANCE KINDRICK PATTERSON: Well he's just so very different from the rest of the family. And then she's labeling him as "black sheep." And I'm getting more into the brother's role here, because he really does model a pretty healthy distance from the family and finding another way of being in the world. And so it's an opportunity for her, I think, to consider how someone in the family has found some distance from that conservatism, to live a life fully that still is a caring connection.

But he's different. He's found that distance that works for him. And still he's welcome in the household and he's loved in the household. This is an interesting model for her, perhaps.

DR. NINA NABORS: Yeah. And I also was picking up on the whole black-sheep thing, that somehow if she were to do likewise, she too would be a black sheep in the family.

TRACY: He left our home-- gosh, he was 17 when he left. And he went across the country to college.

You know, we had gone to conservative colleges. He went to a very large university and got involved in an arts program and film. And he's just so different. People meet him and they're shocked to know that he's part of our family.

My older brother is so much like my dad. And I'm kind of like both my parents, I guess. And the younger brother is just so different. It's like he came out of a different family and they switched him in the hospital.

And I think he's more accepting. He's got a much more wide group of friends that aren't all like him, necessarily. So my hunch is he wouldn't be as upset. I don't know. I don't think he would be as upset.

DR. CONSTANCE KINDRICK PATTERSON: Is it a bad thing that he's so different from the rest of the family? How do the other family members respond to that?

TRACY: That's a good question.

DR. NINA NABORS: What are you getting at there in asking that question?

DR. CONSTANCE KINDRICK PATTERSON: I think It's important for her to consider what's the meaning of his being so different, and is there a possibility for her to be different and still be cared about by this family. And I think that's a really hard concept for her because she's like her mom and her dad. And her older brother is like dad. She's like them. It's hard for her to think about breaking out of that mold of being like them, I think.

DR. NINA NABORS: So you're basically calling it. What she was just implying, you're just stating it. You're suggesting that maybe he's-- this is a negative thing--

DR. CONSTANCE KINDRICK PATTERSON: Is it a bad thing?

DR. NINA NABORS: Let's explore that.

DR. CONSTANCE KINDRICK PATTERSON: Or is it not a bad thing?

TRACY: I think it was harder for him when he was younger and he had to figure out how he could be who he was in our household, when he wasn't old enough to just get up and go and then when he was old enough to get up and go. It seems

like he's done pretty well for himself, in terms of finding friends and stuff that act like family for him. I mean, he's still welcome at home. And he'll come home for some holidays, but--

DR. CONSTANCE KINDRICK PATTERSON: It sounds like he's created a nice group of people who are family like and very caring for him outside of the family.

TRACY: Yeah.

DR. CONSTANCE KINDRICK PATTERSON: Again, creating some possibilities there that there may be other options for her.

DR. NINA NABORS: OK. And someone in the family modeling that.

DR. CONSTANCE KINDRICK PATTERSON: Is there some loss for him in making that distance between the family and himself?

TRACY: Hm. You know, I never thought about it.

DR. CONSTANCE KINDRICK PATTERSON: And I ask because as you move into exploring different possibilities, the possibility is that you do make some distance between, especially-- not knowing where you're going with this, certainly. But the possibility of moving away from your family a little bit or a lot may entail some loss for you. And I don't know what-- I mean, it's likely to entail a number of different kinds of responses from them. But thinking about what that trade off was for him may be constructive for you to think about.

TRACY: Right, right.

DR. NINA NABORS: Let me pause it here. I want to pick up on something you did just a second ago, not knowing where you're going with this.

DR. CONSTANCE KINDRICK PATTERSON: Because I think at this point she's really questioning. She's not really owning something different. She's exploring possibilities. And as her therapist, I don't want to make any judgment about that's where she's headed. She may in fact do a lot of questioning and decide that her life is just fine.

Being able to fully question and to create an environment where she can continue to question is quite important. And I think that for someone who is very conservative, whose entire life has been one of adhering to very conservative religious background, whose parents would be very, very judgmental to get too far into this too fast, it's really her pacing. It's her decision how fast she wants to go with this.

And so taking it very carefully and saying, I'm not sure where you're going to go with this, the possibility is one way, you have all the choices here. And so communicating that in a number of ways, that it's her choice to pace it, it's her choice to question and move into this in any way that makes sense to her is very important. I think the risk is that all of the sudden she would say, oh no, I can't do this, if you push too far too fast.

DR. NINA NABORS: That's what I was wondering, yeah. That's the risk.

DR. CONSTANCE KINDRICK PATTERSON: I mean, suggesting and then stepping back and saying, maybe or maybe not, it's really your choice to explore this and decide.

DR. NINA NABORS: So affirmative therapy is really about making an environment open for a client to explore.

DR. CONSTANCE KINDRICK PATTERSON: Yes. And really thinking about, in the context that you've learned this life that you're living, how does what you're considering challenge what you've lived so far? And I think allowing her, then, to think about, how might it be different if I make this choice? Or how might it be different if I don't make this choice?

You know, she just talked a little bit earlier about, she really likes her husband. He's a nice, nice person. But she's not happy with nice, nice. Even though she's been socialized for the role that she's just taken on a year ago in getting married, she's really questioning how that fits. Now I'm not going to say, perhaps this was not the time for you to get married.

DR. NINA NABORS: Yes, yes.

DR. CONSTANCE KINDRICK PATTERSON: But she's certainly taking some time to think about that, certainly worrying about how that actually fit.

DR. NINA NABORS: Got it. It

TRACY: You know, I think I've gotten so used to trying to think about how to avoid it, or to lessen any kind of tension or problems so that I wouldn't have to deal with really changing my relationship with my parents that I haven't even really thought about how would it be to not-- what if stuff came up, and it meant that the way that I interacted with my parents changed.

DR. CONSTANCE KINDRICK PATTERSON: Do you want to think out loud together about some of that? What if stuff came up?

TRACY: Oh, Lord.

DR. CONSTANCE KINDRICK PATTERSON: It's a rather tentative thing here to do, to say, what if stuff came up. I mean, I'm inviting. Shall we talk about this together or would you want to talk about this together? But just saying, what if stuff came up, she has this response that's quite stressy feeling.

DR. NINA NABORS: Right. I was noticing that.

DR. CONSTANCE KINDRICK PATTERSON: So leading her into just starting to label some of that potential disclosure, but letting her take the first plunge at that by saying something about stuff coming up. It's an uncomfortable set of concerns for her.

DR. NINA NABORS: Yeah, that's certainly clear. And it looks like you're handling it really well of the trying to go at her own pace. It really makes a lot of sense.

TRACY: It just makes me nervous even thinking about it. That would be so-- well, they'd be angry. My father would be angry.

DR. CONSTANCE KINDRICK PATTERSON: OK. But let's define "stuff." What scenario would be--?

TRACY: Well, let's start if I told them I was leaving my husband.

DR. CONSTANCE KINDRICK PATTERSON: OK.

Certainly an important issue but not what I was expecting her to say, honestly.

DR. NINA NABORS: Ah. What were you expecting?

DR. CONSTANCE KINDRICK PATTERSON: Well I was really thinking this whole business with Lenore keeps stirring up this issue of being a lesbian. Perhaps she's a lesbian. But the first thing she needs to deal with with the family is what if she would leave this relationship? So important for her to go there first.

DR. NINA NABORS: I see. And so do you have any-- is it a perception she's running from? Or she's had to take it in small steps or something?

DR. CONSTANCE KINDRICK PATTERSON: I think she probably has to take it in small steps. That would be a big shock to her family. But probably not so big a shock as challenging their rather conservative religious conceptions of her if she were to talk about her sexuality.

DR. NINA NABORS: OK.

DR. CONSTANCE KINDRICK PATTERSON: Their response would be-- what do you anticipate?

TRACY: I think my father would be angry. He gets angry. And it comes out and, I mean, why are you doing this, and everything seems fine, you've got a good situation, why would you-- what are you thinking, kind of thing.

DR. CONSTANCE KINDRICK PATTERSON: So he'd respond in a negative way, not asking you why or--?

TRACY: No, I don't think he would. I think he thinks right now we have a good marriage. And it's got all that appearance of being fine. So I don't think in his mind he would understand what reason I would have to leave.

I think my mom would be hurt and sad.

DR. CONSTANCE KINDRICK PATTERSON: And hurt because?

TRACY: Well, I don't think she would understand why either. And I think should be disappointed.

DR. CONSTANCE KINDRICK PATTERSON: Would she ask you why?

TRACY: Yeah. And that opens a whole other can of worms. Because how I would tell her or what I would tell her would be-- I mean, it would be hard enough to just tell her that I was going to leave my husband. And to then try and explain-- I mean, if I told her, hey mom, I'm not ready to talk about it.

DR. CONSTANCE KINDRICK PATTERSON: And she's clearly not ready to talk about it.

DR. NINA NABORS: Even in this session.

DR. CONSTANCE KINDRICK PATTERSON: She can't articulate why she might leave her husband. She can't articulate a reason.

DR. NINA NABORS: Right. I'm noticing she's not even able to articulate it to you.

DR. CONSTANCE KINDRICK PATTERSON: Right.

TRACY: Then she'd probably back off and leave me alone. But that probably is just my wanting to avoid it a little bit.

DR. CONSTANCE KINDRICK PATTERSON: Just put it off.

TRACY: Yeah.

DR. CONSTANCE KINDRICK PATTERSON: So what if you said, you know mom, I can't live in this relationship because it's not who I am, and try to explain to her that was just not something you could live anymore?

DR. NINA NABORS: What's your goal there, giving her that suggestion of how to talk to her mom?

DR. CONSTANCE KINDRICK PATTERSON: I think trying to get her to articulate something about the changing sense of her identity, and again, an invitation for her to move just a little farther beyond just leaving her husband. If she could begin to put that into words, I think she'd be moving along toward making some decision, exploring deeper.

DR. NINA NABORS: OK.

TRACY: I think actually she might still want to know. But she might say, OK let's-- you know. I think she'd be worried about me, too. And I think that's part of the being upset.

And I think if she thought that-- because she'd be concerned that I was going to be hurt and this was going to be hard. And I think if she thought that this was the right decision and that this was going to be a better thing for me, that that would make her feel better. And then she might be more understanding and accepting, and willing to let me not get into the details, initially.

DR. CONSTANCE KINDRICK PATTERSON: Well I know you're not close to making any real decisions here. So can we just play with this idea a little bit more, and think out loud together about it? I don't want to push you.

TRACY: No, no, that's OK.

DR. CONSTANCE KINDRICK PATTERSON: And it's still questions. You know, it's still questions.

TRACY: Yeah. Still questions.

DR. NINA NABORS: You're sort of reassuring her there, I don't want to push you.

DR. CONSTANCE KINDRICK PATTERSON: I want her to feel comfortable playing with the idea without making any commitment to the identity until she's ready, if she becomes ready. But again, inviting her over and over through working with her, what might this be like? With What might this be like if you decided to live this way? What might this be like if we were to go just a little farther into this concept of yourself?

DR. NINA NABORS: So again, sort of an invitation, but at her own pace.

DR. CONSTANCE KINDRICK PATTERSON: What if you said to her, mom, I really believe that I'd be happier in a relationship with another woman?

DR. NINA NABORS: Did you notice any affect there when you said that?

DR. CONSTANCE KINDRICK PATTERSON: It's a sort of tense response.

DR. NINA NABORS: Yeah, yeah. Wow.

DR. CONSTANCE KINDRICK PATTERSON: You're almost gritting your teeth as I say this to you.

TRACY: I know. I can't even imagine saying to her. What if I said-- wow. I could just hear say, oh honey, I just don't understand.

DR. CONSTANCE KINDRICK PATTERSON: So you think that would really be outside of her conception of you, her idea of what your world could be like?

TRACY: Yeah. You know, I could actually see-- I think maybe it might be hard for her to talk to me about it, initially. Because I think she'd be confused and she wouldn't really understand. But I think even if maybe my brother were around, my younger brother, to help. She might feel more comfortable talking to him a little bit about it before she came back to me with some of this stuff.

DR. CONSTANCE KINDRICK PATTERSON: Because he just thinks more broadly about things, or--?

TRACY: Yeah. I think because the way he's just gone off and has done his own thing that she wouldn't feel as awkward talking to him about it, or asking him a question than asking me directly about it, initially.

DR. CONSTANCE KINDRICK PATTERSON: So you'd be able to rely on him to broaden her perspective a little bit before the two of you might talk in more depth about that.

TRACY: Yeah, maybe.

DR. CONSTANCE KINDRICK PATTERSON: Again, all speculation at this point. Just exploring ideas about that.

TRACY: Yeah.

DR. NINA NABORS: I want to stop it there. I think we've got a really good sense of what the client is experiencing and the great work you're doing in working with her. I don't know if you mentioned earlier in the tape, but this is a session about a month into your therapy with her, right?

DR. CONSTANCE KINDRICK PATTERSON: Right.

DR. NINA NABORS: What are your overall impressions of the client at this point? And where would you like to go from here?

DR. CONSTANCE KINDRICK PATTERSON: Well I think in this particular session, one of the things that I would ask her to do-- because she's beginning to examine the possibility of roles that she hasn't thought about before. The parent role, for example, is something that she really didn't think she would ever do. And yet, she's beginning to think about that in the context of perhaps not the relationship she has now. But because she was exposed to this lesbian couple at this dinner party who have a family, it somehow opens up other possibilities in her life.

And so I would say, the local GLBT center has a family day. There's some pictures online. Let me give you the web address. Take a look and see if that raises any kinds of issues for you.

And then I would be much more direct with her as we started to process some of her responses to that, talking about gay couples, lesbian couples, and really labeling more specifically some possibilities that might provoke a little more anxiety for her, but really flushes out possibilities and a direction she's just now starting to think about. And I think in some ways that may be less threatening to her because it's a new idea, versus the ways that she's going to have to struggle with the family issues.

DR. NINA NABORS: Sort of separate those things.

DR. CONSTANCE KINDRICK PATTERSON: Yeah. It's interesting here that she really sees the brothers as a possible ally in helping her broker this new idea of who she is with the family. So she's beginning to entertain some ideas about how her mother may respond to a new identity that she may present to them, which is also a place that I would like to continue to explore.

What are the possibilities? What responses might people make to her if she were to make this kind of decision? Allow her to try on some different ideas about that and really think clearly about potential losses, as well as how that might change your relationships. And are there ways for those relationships to go on in a positive way.

Her brother's managed to do that. It may be difficult. But there may be ways for her to do that. So continuing to offer possibilities to explore without really pushing too much too fast.

DR. NINA NABORS: OK. In looking at the session and thinking back on your discussion with her, are there any things that you might have done differently?

DR. CONSTANCE KINDRICK PATTERSON: I think that perhaps going ahead and labeling the couple as a lesbian couple, to put some verbiage in there, some terms in there that would give a broader possibility of her thinking a little more specifically might be a possibility. But again, that's an iffy situation because I don't want to push too far or label too explicitly.

At the same time I want her to think clearly about, this is not about sexual attraction. This is about lives. And this is about possible changes in her own life and her own roles in her life. And to put some terminology in there that would give her some perhaps more specific expectations, or some more explicit ideas about what that could be like.

DR. NINA NABORS: So maybe played around with it a little more. But still being cautious, in terms of how far you--

DR. CONSTANCE KINDRICK PATTERSON: Pacing slowly, but I think to begin to label a little more specifically so that it becomes part of our shared vocabulary.

DR. NINA NABORS: OK. And it sounds like, again, having worked with her for a month, you certainly appeared to have built up a report. And she seems very comfortable.

DR. CONSTANCE KINDRICK PATTERSON: She does. She's not real comfortable-looking person. She's a rather tense person.

And I think that as I ask questions that are a little more pointed or a little more specific, the jaw thing, the [INHALES SHARPLY] sort of response to some of that communicates that she's willing to go there. But there's a tentativeness on my part to push much faster. You know, I don't want to push her away.

DR. NINA NABORS: And that actually brings me to my last question. And I'm going to ask you to speculate here. So that's what I'm asking you for.

So with affirmative therapy, it sounds like it's about affirming and providing an accepting environment for the client to explore. So if you didn't practice this particular form of therapy with this client, and instead you were more traditional in your own views, if you will. How might that impact her differently?

I guess I'm asking you if you had a particular bias about sexual orientation, how might you interact with this client? How might you respond to what this client is bringing to therapy? I'm trying to get at, what are the dangers of working with this client without having knowledge about this particular form of therapy?

DR. CONSTANCE KINDRICK PATTERSON: My immediate response to your question would be, if I were not comfortable, I would refer her to someone who

had the expertise, who had the acceptance level to explore with her carefully her options in her life.

DR. NINA NABORS: So that's again an understanding that there are alternative viewpoints. As opposed to taking her reluctance as a sign that she really isn't and she needs to--

DR. CONSTANCE KINDRICK PATTERSON: She needs space and time to explore the possibilities. I can't speculate. Three months down the road she may say, you know, it's all interesting but it's not me. And I would like to think that in those three months that we would have given her an opportunity to thoroughly explore the ideas, the concepts, the feelings, and have come to a comfortable decision about her identity.

DR. NINA NABORS: That makes sense. That makes a lot of sense. Wonderful. Well this is very helpful. Thank you.

DR. CONSTANCE KINDRICK PATTERSON: Thank you for the opportunity.