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Sexuality Research and Social Policy ISSN 1868-9884 Sex Res Soc PolicyDOI 10.1007/s13178-016-0240-2

The Problem with the Phrase “IntersectingIdentities”: LGBT Affirmative Therapy,Intersectionality, and Neoliberalism

Patrick R. Grzanka & Joseph R. Miles

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The Problem with the Phrase BIntersecting Identities^: LGBTAffirmative Therapy, Intersectionality, and Neoliberalism

Patrick R. Grzanka1 & Joseph R. Miles1

# Springer Science+Business Media New York 2016

Abstract Since the declassification of homosexuality as amental illness in 1973, psychology has transformed the wayit approaches sexual orientation and gender identity issues inscientific research and clinical practice. The paradigmatic shiftfrom psychopathology to identity has corresponded with theintroduction of BLGBT affirmative therapy,^ which suggeststhat therapists should affirm clients’ sexual orientations ratherthan reinforce sexual minorities’ experiences of stigma andmarginalization. This qualitative study used a subset of psy-chotherapy training videos about LGBT issues to explore theform of content of LGBTaffirmative therapy in the context ofincreased attention to identity and multiculturalism in appliedpsychology. The videos suggest that multiculturally compe-tent therapists should understand sexuality and gender issuesin terms of what psychologists call Bmultiple^ orBintersecting^ identities, namely race and ethnicity. Whilethe multicultural turn in psychotherapy may signal a transfor-mation in mental health service provision, our analysis ques-tions whether these videos may unintentionally reflect a neo-liberal logic of inclusion that obscures the structural dimen-sions of social inequality. We suggest that the uptake ofintersectionality-like identitarian discourse in psychotherapyin particular offers opportunities for challenging and reinforc-ing neoliberalism.

Keywords Sexual orientation . Gender identity .

Psychotherapy . Intersectionality . Neoliberalism

Approximately 13 % of adults in the USA receive mentalhealth treatment in the form of counseling or psychotherapy(U.S. Department of Health and Human Services, SubstanceAbuse and Mental Health Services Administration, Office ofApplied Studies 2006). Lesbian, gay, and bisexual individualsaccess mental health care at disproportionately higher ratesthan their heterosexual counterparts (Cochran et al. 2003).Leading up to and intensifying after the declassification ofhomosexuality as a mental illness in 1973, there has been averitable explosion of research, training, and practice on les-bian, gay, bisexual, and transgender (LGBT) psychology,broadly, and on BLGBT affirmative therapy,^ specifically(Johnson 2012). This discourse on LGBT affirmative therapyhas included research and educational materials that aim toproduce and disseminate de-pathologizing science aboutLGBT people with which therapists may conduct identity-affirming therapies (Pettit 2011). These affirming therapieschallenge the socio-historical context of structural heterosex-ism and cisgenderism in which most traditional forms of ther-apy developed, including so-called conversion therapies thatseek to re-orient or inhibit individuals’ sexual desires(Waidzunas 2015).

In epistemic terms, the latter decades of the twentieth cen-tury and the beginning of the twenty - first century may bedescribed as an opening up of psychotherapy—as discourseand disciplinary apparatus—to a new ontology of sexualityand gender identity (Foucault 1970/1994; Foucault 1972;Parlee 1996). The de-pathologized and potentially healthyLGBT subject presents epistemic, ontological, ethical, andpractical problems that are multifarious and interconnected(Pettit 2011). Our interdisciplinary research seeks specificallyto empirically interrogate the knowledge-making practices ofthe Baffirmative^ psychology of sexual orientation and genderdiversity. We take a feminist, queer, and intersectional ap-proach to the sociology of science by investigating the form

* Patrick R. Grzankapatrick.grzanka@utk.edu

1 Department of Psychology, University of Tennessee, 1404 CircleDrive, Knoxville, TN 37996, USA

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and content of the dynamic science of LGBT psychology, andthe ways in which it congeals into norms and procedures forthe mental health treatment of sexual minorities and trans peo-ple. We situate LGBT affirmative psychotherapy within thecontext of contemporary neoliberal social and economic poli-cies, which recent scholarship and activism suggests have im-plications for arenas of social life that might appear to beindependent of the realm of the economy (Duggan 2003;Brown 2006). Analyses of neoliberalism’s effects on quotidiansocial dynamics (Brown 2015)—which we extend to the ev-eryday practices of psychological scientists and practi-tioners—possess an illuminative capacity to render visiblethe ways in which late-capitalist market logics may subtlyshape the production, use, and dissemination of psychologicalknowledge. As prior research has also demonstrated, neoliber-alism may be a particularly useful lens through which to viewthe uptake of diversity and inclusion discourse in institutionalcontexts and settings, even and especially ones that claim toembrace a multicultural ethos (Epstein 2007; Ahmed 2012).

In thismanuscript, we focus on one slice of a larger groundedtheory-driven analysis of a recently produced archive of over1200 minutes of therapist and counselor training videos pro-duced by psychologists and licensed to universities. The videoswe analyzed were catalogued as pertaining to the topic ofBsexual orientation,^ though they explore a wide range oftopics, including gender identity, and some of which are onlyminimally focused on sexual orientation (see Table 1). Thevideos are also heterogeneous in form: some are lectures ordocumentary-style informational films, and others are mocktherapy sessions with trainees and actual clients. As textual data,they are compelling for many reasons, not the least of which isthat they explicitly state the work they collectively intend to do:assist in the training of LGBT affirmative therapists. From acritical, social constructionist perspective, we imagine this asan archive that is designed to the do the work not only oftraining LGBT affirmative therapists, but actually Bcreating^the science and practice of LGBT affirmative therapy, whichis still relatively nascent compared to other forms of therapy(Bieschke et al. 2007; Mallinckrodt 2009; Johnson 2012).

Through our analysis, we uncovered a discourse in thevideos that we situate within the larger history of LGBT psy-chology and refer to as the era of LGBT Baffirmation,^ elab-orated here particularly in terms of its implications for howpsychologists think about and attend to issues ofintersectionality within the socio-historical context of neolib-eralism. First, we provide an historical framework for delin-eating major eras in LGBT psychology, including continuitiesand discontinuities in the science that stretch across decades,and we introduce the Bmulticultural turn^ in applied psychol-ogy and its relevance to LGBT psychotherapy. Next, we de-scribe our methods and key findings, offering specific exam-ples from the training videos to illustrate key analytic themes.We concludewith a discussion of the implications, limitations,

and future directions of our work with a focus on psychother-apy training and the future of affirmative psychotherapy ap-proaches with LGBT clients.

Psychotherapy in/and Society

Our project attempts to unify both practical and critical con-cerns by documenting and synthesizing the content of thesetraining videos while also reading this content across extantliteratures in psychology, sociology, and science and technol-ogy studies (STS). The history of homosexuality and itsBtreatment^ in medical science—especially psychiatry—hasbeen well documented by historians, sociologists, and philos-ophers of science (e.g., Foucault 1978; Bland and Doan 1998;Terry 1999; Irvine 2005), but scholars in STS and relatedfields have given less attention to psychotherapy itself, andmuch less to sexuality and gender identity issues in therapy.Consequently, most knowledge about sexual orientation andgender nonconformity in psychology has been produced byand for psychologists, as opposed to STS scholars, who studyscience as an immanently social process and who explore itsoutcomes in terms of social policy.

LGBT Psychology in Historical Perspective

Affirmative approaches to psychotherapy with LGBT clientsare both distinct from and similar to earlier paradigms forconducting psychotherapy with this unique and dynamic pop-ulation. Psychologists, as well as some STS scholars (broadlyconstrued), have studied the history of sexual minorities andgender nonconforming individuals’ treatment in psychologi-cal science and illustrated the diversity of ways in whichLGBT individuals have been defined and approached sincethe late nineteenth century (e.g., Bullough and Bullough1997). For example, Hammack et al. (2013) took a critical,narrative approach to psychological research on same-sex de-sire and argued that three paradigm shifts or Bmasternarratives^ dominate the history of psychological meaning -making around non-heterosexual desires and behaviors.Hammack et al. suggest that an initial Bsickness^ frameworkcharacterized by pathologization preceded a Bspecies^ para-digm in the 1970s in which gay men, lesbians, and bisexualsachieved legitimate personhood. Finally, the cultural transfor-mations of the 1990s introduced a Bsubject^ narrative inwhich greater attention to the heterogeneity of LGB peoples’lived experiences—somewhat influenced by queer theoreticalapproaches (cf. Minton 1997)—challenged the species narra-tive and began to undermine rigid taxonomies of sexual ori-entation. Although Hammack et al. acknowledge that the psy-chology of sexuality is hardly homogenous or uniform in itsconclusions, their framework is consistent with other

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Table 1 Titles, Alexander Street Press categorizations, and length of video achieve

Title of video (production year) Categorizations (as of August 2015) Length(min)

A.I.D.S. at 21: It wasn’t supposed to happen like this(2004)

Subject: Sexual orientation; Topic/theme: psychological issues, sex and sexual abuse,African-Americans, medications, health, monitoring groups, self image, selfconfidence, sexually transmitted diseases, sexuality-related themes, homosexual pop-ulations, acquired immune deficiency syndrome, HIV infection (symptomatic)

26

At the corner of me and myself: Voices of multiple socialidentities* (2006)

27

Behavioral couples therapy (2010) Subject: counseling and therapy; Topic/theme: theory, family and relationships,counseling and therapy, intimacy, sexuality-relate themes, behavioral psychology,spousal relationships, behaviorism, behavior therapy, relationship therapy;Therapeutic/approach: behavioral therapy

115

Break at silence: The power of witnessing, A.R.T.program for teens (2009)

Subject: sexual orientation; Topic/theme: education, development groups, youthdiscrimination (behavioral), sexual diversity, religious diversity, culturalsensitivity, multiculturalism, ethnic diversity, racial diversity

26

Coming out: Voices of gay and lesbian teens and theirfamilies (2008)

Specialized area of interest: lesbian, gay, bisexual, and transgender counseling;Subject: sexual orientation; Topic/theme: youth, gender, social support, suicide,teenage adjustment, homosexuality, homosexual populations

40

Counseling gay and lesbian people of color: Multipleidentities: Part 1 (2011)

Specialized area of interest: lesbian, gay, bisexual, and transgender counseling;Subject: sexual orientation; Topic/theme: demographic groups, sex and sexualabuse, race, counseling and therapy, multiculturalism, ethnic diversity, racialdiversity, heterosexism, multicultural counseling

28

Counseling gay and lesbian people of color: Multipleidentities: Part 2 (2011)

Specialized area of interest: lesbian, gay, bisexual, and transgender counseling;Subject: sexual orientation; Topic/theme: family and relationships, gender, sexand sexual abuse, counseling and therapy, family relations, immigrant populations,homosexuality, sexuality-related themes, homosexual population, multiculturalcounseling

29

Counseling gay and lesbian youth (2005) Specialized area of interest: lesbian, gay, bisexual, and transgender counseling;Subject: sexual orientation; Topic/theme: sex and sexual abuse, identityconfusion, sexual orientation, sexual identity, anxiety, sexual orientationcounseling

84

Cultural competence in the helping professions (2003) Subject: sexual orientation; Topic/theme: race, cultural diversity, ethnic diversity,sexual diversity, racial diversity, multiculturalism counseling

78

Lesbian, bisexual, gay, and transgendered counseling:Awareness and knowledge* (2001)

88

Lesbian, bisexual, gay and transgendered counseling:Skill-building vignettes (2001)

Specialized area of interest: lesbian, gay, bisexual, and transgender counseling;Subject: sexual orientation; Topic/theme: sex and sexual abuse, psychologicalissues, homosexual populations, bullying, self esteem, counseling skills, sexualorientation counseling, role play; Therapeutic approach: sexual orientationcounseling

77

Multiculturalism in psychology education andtraining (2009)

Subject: sexual orientation; Topic/theme: demographic groups, education,development, and training, cultural sensitivity, gender diversity, sexual diversity,racial diversity, cultural diversity, multiculturalism, multicultural counseling

40

Overcoming barriers to effective multiculturalcounseling and therapy (2003)

Specialized area of interest: multicultural counseling; Subject: sexual orientation;Topic/theme: theory, race, sex and sexual abuse, gays, counselors, psychology,counseling skills, sexual diversity, cultural diversity, racial diversity, biases,multicultural counseling

91

Queer theory in action: Theoretical resources fortherapeutic conversations, part 1 (2011)

Specialized area of interest: lesbian, gay, bisexual, and transgender counseling;Subject: sexual orientation; Topic/theme: gender, counseling and therapy,parent–child relationships, Asian Americans, transitions, transsexual populations,counseling

111

Queer theory in action: Theoretical resources fortherapeutic conversations, part 2 (2011)

Specialized area of interest: lesbian, gay, bisexual, and transgender counseling;Subject: sexual orientation;Topic/theme: gender, counseling and therapy, genderidentity, gender roles, transgender sexuality, transsexual populations, transitions,counseling

74

Race, gender and sexual orientation: Counselingpeople with multiple cultural identities (2005)

Specialized area of interest: lesbian, gay, bisexual and transgender counseling;Subject: sexual orientation; Topic/theme: sex and sexual abuse, race, gender,cultural identity, sexual orientation, multicultural counseling

48

Sex and aging: Overcoming the obstacles tomaintaining a vital sex life (2000)

Specialized area of interest: marriage and family counseling; Subject: sexualorientation; Topic/theme: sex and sexual abuse, gender, sexual relationships,sexuality-related themes, aging

62

Sex therapy (2000) Subject: sexual orientation; Topic /theme: sex and sexual abuse, family andrelationships, counseling and therapy, drug abuse, family relation, sexuality-related

101

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historical tracings of US psychology’s epistemology ofsexuality and its tenuous relationship to the science of sex/gender, such as Irvine (2005) and Terry (1999). Terry’s(1999) authoritative work on the US science of homosexualityextends beyond psychological research but similarly framesscientists’ fixation on the Btruth^ of same-sex/gender orienta-tions as a kind of obsession. According to Terry, the nature ofsexual orientation was presumed a priori, and a massive sci-entific infrastructure was built up around it to confirm whatscientists already believed: sexual orientation must reside inthe body (or, more specifically, the mind, the brain, or thegenetic code) (see also Stein 1999). For example, in responseto conservative attacks on the rights of sexual minorities in thelate 1970s and early 1980s, the Society for the PsychologicalStudy of Social Problems’ Task Force on Sexual Orientationultimately incorporated sociobiology as a conceptual frame-work for explaining the nature of sexual orientation and therights of sexual minorities; according to Pettit (2011), the taskforce was Breluctant to define homosexuality purely in termsof the social; the biological was seen as crucial in the forgingof an identity and securing political rights^ (p. 102).

Essentialist, positivist approaches to taxonomizing sexual-ities did not exclude concern about other dimensions of socialdifference, however. For example, Bryant (2006) connects thediagnosis of childhood gender identity disorders to cultural anx-ieties about homosexuality (i.e., gender nonconforming childrenwere presumed to be Bat risk^ for adult homosexuality), andSomerville (1994) similarly connected the science of(homo)sexuality to scientific research on race and gender (seealso Fausto-Sterling 2000; Valentine 2007; Karkazis 2008;Ansara and Hegarty 2012). Bland and Doan (1998) collectedmany of these early studies from the late nineteenth and earlytwentieth centuries and presented them as a diverse array of

projects that may seem obviously heterosexist and cissexist fromthe standpoint of a twenty - first century researcher, but whichultimately served as the epistemic foundation for contemporarypsychological inquiry into the nature of sexuality and gender.

These critical, historical perspectives on psychologicalscience influenced the shape of our study, including ourresearch questions. Informed also by queer and feministtheories of sexuality and science (Foucault 1970/1994;Foucault 1978; Butler 1990, 1993; Haraway 1997;Minton 1997; Seidman 1997), we synthesized these liter-atures and attempted to develop a historical framework ofLGBT psychology that: (1) accounts for theory, research,and practice and (2) includes how both transgender expe-riences and same-sex desires were defined and treated inresearch and psychotherapy (see Table 2). Similar toHammack et al. (2013), we suggest three paradigms oreras, beginning with Bpathologiziation^ (1870s–1970s)and followed by Bincorporation^ and Baffirmation.^ Thecontent of the pathologization and incorporation eras wasgenerated by our synthetic literature review, whereas thecontent of the affirmation era was generated from ouranalysis of the psychotherapy training videos and the it-erative process of reading our findings across extant liter-atures (see BFindings^). Indeed, because our argumentabout the era of affirmation is based on our review ofrelevant literature and our analysis of the videos, it isarguably more interpretive and potentially biased thanour claims about the other two eras, which are more trans-parently derived from extant literature. Table 2 outlinesour distinctions between the eras but also highlights im-portant consistencies in the science and practice of LGBTpsychology, including a focus on cisgender White men,el is ion of intersex concerns, pathologizat ion of

Table 1 (continued)

Title of video (production year) Categorizations (as of August 2015) Length(min)

themes, sexual relationship, spousal relationships, complications of pregnancy, child-birth and the puerperium, sex therapy; Therapeutic approach: sex therapy

Sexual orientations in perspective (2001) Specialized area of interest: multicultural counseling; Subject: sexual orientation;Topic/theme: sex and sexual abuse, theory, sexual orientation, counseling skills,homosexual population, sexual orientation counseling; Therapeutic approach:sexual orientation counseling

65

Straight privilege (2011) Specialized area of interest: lesbian, gay, bisexual and transgender counseling;subject: sexual orientation; Topic/theme: gender, sex and sexual abuse,counseling and therapy, heterosexism, heterosexuality, bisexuality, homosexuality,homosexual population

33

Working with diversity in counseling (2008) Topic/theme: race demographic groups, counseling, therapy discrimination(behavioral), homosexuality ethnic identity, racism, racial identity, cross culturalcounseling, multicultural counseling

55

Total 1298

Note. *Videos are no longer available. Bolded videos represent those that were in our theoreticalsample. The ASP CTIV database is a rapidly growingand evolving video archive. The above videosrepresent what was available when when we began our analysis in 2012. Videos that were added laterwerenot included in our analysis

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Table 2 The shifting landscape of LGBT psychology, research, and practice

Pathologization Incorporation Affirmation

Researching homosexuality

Typology/taxonomy Typology/taxonomy Identity

Sickness, disease; a focus on the illness of thesubject

Recuperation of the LGB subject; recognition ofLGB personhood; trans* identities remainpathologized

Celebration of the LGBT subject withinmulticultural discourse, though trans*identities retain official pathologization

Morality, social pathology; homosexuality as asocial contagion

Challenging the moral discourse aroundhomosexuality; separating moral concernsfrom the scientific

Science embraces a liberal politics; LGBTpsychology is inherently political if notexplicitly activist

Biological homosexuals: the male homosexualand the lesbian body

The lesbian, gay man and emergent bisexual(LGB); toward a focus on identity

BLGB^ and increasingly BLGBT^ individuals

Sexology, biology, biological anthropologyframe psychological inquiry into identity aspsychoanalytic paradigms increasingly retreatfrom scientific research on sexuality

Clinical and social psychology paradigms,increasingly influenced by feminisms and themainstreaming of the gay rights movement;some insight from early queer theory

Counseling andmulticultural feminist paradigms,differentially influenced by queer theory andintersectionality

Homosexuality is about sexuality and gender(often conflated)

Homosexuality is mostly about sexuality,separate from gender identity disorders

Sexual orientation and gender intersect with otherelements of identity, cultural and socialdifferences, especially race, ethnicity, class,and geographic location (rural vs. urban, Westversus East)

Research fetishizes difference Research neglects within-group differencesamong LGB people

Research recognizes differences within LGBgroups but retains focus on White gay andlesbian subjects; research on racial/ethnic mi-norities is niche

Illness and choice as the sources of homosexualbehaviors and identities; homosexuality can berehabilitated through behavioral, surgical, and/or chemical interventions

Rise of neuroscience, neuropsychology, sociobiology, and genomics; biomedicalization increasinglyaffirms the naturalness of sexual orientation categories; origins of sexual orientation increasinglyassumed to be rooted in the body, even as empirical evidence remains elusive; Bgay gene^ andBborn this way^ hypotheses dominate clinical research

Defining the subject

The subject is defined by sexual practices and/ororientation, gender

The subject is defined by sexual practices and/ororientation, gender

Sexual orientation is not the only definitiveelement of the LBGT subject, e.g., race,ethnicity, gender, class, religion

Hyper-sexualized subject Sexualized subject Desexualized subject

Depoliticized subject; the homosexual lacksgroup-based politics; social life is limited tosexual interactions

The homosexual subject is deeply politicizedaround gay rights and HIV/AIDS activism

Depoliticized subject; LGB individuals seeknormalcy

Race, gender and sexual differences areunacknowledged but shape the constitution ofthe homosexual subject/body, particularly theBlack-White binary and sex (male/female) andgender (masculinity/feminity) binaries

Politicized White gay subject, HIV positive gaymen dominate understandings ofcontemporary gay experiences; between-groupdifferences among sexual minorities are large-ly flattened

Plurality of subjects considered andacknowledged but research still focuses onWhite men’s experiences

Homosexuals, inverts, perverts, queers,pedophiles, transvestites, multiplication ofqueer identities (both scientifically andculturally constituted)

Queer identities coalesce around LGB(T) labelsas unified sexual minority group, driven byLGBT activism, the de-pathologization of ho-mosexuality and the emergent taxonomy ofgender identity disorder

L, G, B, T increasingly treated as discrete,highlighting between-group differencesamong these identities; gender identity dys-phoria emerges; intersex concerns begin tomainstream

Lesbian marginality, bisexual shifts from genderidentity to illegitimate sexuality

Lesbian existence acknowledged, bisexuallegitimacy emerges

Lesbian existence, bisexual legitimacy

Fluidity largely downplayed except in cases ofconversion or reparative therapy. Kinsey ismajor exception.

Fluidity bounded by stage models of sexualidentity development

Fluidity in sexual identification over the lifespan,particularly as it pertains to women and trans*people

Homophobia is positioned as normal responses tosocial deviance; structural dimensions of sexualoppression (i.e., heterosexism) are not theorized

Homophobia and heterosexism constitute thesubject’s experiences of oppression

Privilege along multiple dimensions (e.g., class,race, etc.) as central to the subject’sexperiences

Subject’s self-identity is largely irrelevant;Freudian and other sexological understandingsof sexual orientation locate the origins of sex-ual identity in utero or early childhood devel-opment

BComing out^: sexual identity development stagemodels framed bymoving from the closet to anout LGBT identity

Identity development, stage models of identityformation still persist, but challenged by newthemes of identity enactment and rhetorics ofidentity complexity

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transgender subjects, skepticism about the validity of bi-sexual orientations, and the rise of neuroscience.Accordingly, the eras are not meant to denote strict his-torical consecutiveness or mutual exclusivity (e.g., certainpathologizing practices persist across all three eras, andsome early sexologists attempted to affirm non-normativesexualities). This historical perspective is so central toquestions about the science and practice of LGBT affir-mative therapy precisely because this therapeutic ap-proach is purportedly novel and consequentially distinctfrom earlier beliefs and practices (Harrison 2000; Johnson2012). We take seriously Pickersgill’s (2012) call for crit-ical attention to the ways in which scientific and medicaldiscourses are not uniform objects. Pickersgill advocatesforegrounding the ways in which scientific knowledge,biomedical practices, social action, and subjective experi-ences co-produce both psychiatry and each other. In thecase of LGBT affirmative therapy, we ask whether theprogressive claims of queer affirmation may be inadver-tently concomitant with regressive or essentializing tactics(Walters 2014). Our goal is not to laude nor villainizeLGBT affirmative therapy’s proponents, but to examineit—like all sciences—in its complexity, incoherence, andcontradictions, rather than imagine its false singularity,comprehensibility, and consistency.

The Multicultural Turn

Viewed from the intradisciplinary perspective of psychology,specifically applied psychology (clinical, counseling, andschool psychology) and allied fields (e.g., counselor educa-tion, social work), the move toward LGBTaffirmative therapyand the training videos at the center of our project are but onereflection of a larger multicultural revolution in psychotherapyand mental health services, in which there has been a slow andsteady embrace of multicultural issues and human culturaldiversity in mental health service delivery, psychological re-search, and the training of future therapists and professionalpsychologists. From this perspective, this multicultural turn isa transformational, epistemic break from the positivist andpost-positivist paradigms that dominate the discipline and thatare characterized by essentialist and reductionist approachesto the study of cultural diversity, difference, and social in-equality (Eagly and Riger 2014).

The multicultural turn in applied psychology has catalyzeddiversity-related institutional rubrics and policies, includingthe concept of Bmulticultural competency^ (Sue et al. 1982,1992). Formalized by several US-based psychological organi-zations (Arredondo et al. 1996; American PsychologicalAssociation 2002; American Counseling Association 2015)and popularized by myriad special journal issues (e.g.,

Table 2 (continued)

Pathologization Incorporation Affirmation

Doing psychotherapy

Psychoanalytic paradigms retain emphasis onhomosexuality as a disordered from ofsexuality; treatment informed by sexologicalstudies that create the homosexual as pervertedand pathological

Reconciling the legacy of sexology and Freudianpsychoanalysis with emergent LGB andLGBT affirmative therapeutic discourses

Strengths-based, positive psychology, and inter-personal, multicultural frames becomedominant theoretical orientations to treatment

Conversion, reparative therapeutic interventionsto change sexual orientation, gender disordersand behavior

Persistence of Bsexual orientation change efforts^despite institutional calls to end reparativetherapies by the APA

Conversion and reparative therapies, includingBsexual orientation change efforts^condemned by psychological mainstream andmarginalized

Sexual orientation and gender trump all otherforms of social identity when considering thepsychic life of the homosexual client

Sexual orientation should be privileged; sexualorientation is a unique element ofpsychological life and should be treatedaccordingly

Re-conceptualizing multiple social identities asnot necessarily oppositional (e.g., Christianand gay); sexual orientation is not treated inisolation

Power and privilege are not theorized orconsidered elements of treatment ortherapeutic interventions; focus is on the client,not on the client’s relationship to socialstructures

One-dimensional understanding of power andprivilege organized by a hetero-homo binary atthe expense of other dimensions of identity anddifference

Psychological issues (both intra-psychic and in-ter-personal) are linked to relations of powerand privilege; structural considerations are keyto understanding the client’s presenting issues

Sexual orientation is foregrounded in treatment ofsexual minorities as the determining elementof identity

Sexual orientation foregrounded in treatment ofsexual minorities

BMultiple social identities^ is dominant paradigmof identity construction; gestures made bytherapists toward intersectionality(Bintersecting identities^)

Note. Though the three columns above are not meant to denote mutual exclusivity or strict historical consecutiveness, BPathologization^ refers to earlysexology characterized by research and practice from the late nineteenth century (∼1870) through the early 1970s, BIncorporation^ refers to the Bnew^psychology of sexual orientation that emerged after the declassification of homosexuality from the DSM in 1974, and BAffirmation^ refers to discourseof LGBT affirmative therapy since the mid-1990s

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Neville and Carter 2005) and handbooks (Ponterotto et al.2009), multicultural competency typically denotes:knowledge (of diverse groups’ experiences, as well as theconcepts of privilege and oppression), skills (for working withdiverse clients in a culturally appropriate, affirmative, andempowering manner), and awareness (of one’s own biasesand cultural dynamics that might affect the therapeutic alli-ance). Though the multicultural discourse in applied psychol-ogy initially focused on race and ethnicity and distinguisheditself by foregrounding the experiences of racial minorities asthe targets of discrimination (as opposed to socialpsychology’s tendency to study the perpetrators of discrimi-nation), multicultural competencies are not limited to knowl-edge, skills, and awareness about racial and ethnic minorities.Indeed, Ponterotto et al.’s (2009) multicultural counselinghandbook includes a chapter on multicultural competencywith LGBT communities (Wilton 2009); Sue and Sue’s(2012) widely cited textbook includes best practices for work-ing with sexual minorities and gender nonconforming clients;andmulticultural counseling courses in the US now frequentlyinclude training about multiple marginalized groups, includ-ing persons with disabilities, members of the working classand poor, immigrants, the elderly, religious minorities, andLGBT individuals (Koch and Juntunen 2014). For example,Van Den Bergh and Crisp (2004) refer to knowledge, attitude,and skill dimensions of Bcultural competency^ for workingwith LGBT clients, and they position these as central to Bgayaffirmative practice^ (GAP). These competencies includeknowledge about the coming out process, the attitude that anLGBT identity is a positive outcome of coming out, and theskills to deal with the practitioner’s own heterosexist bias.Increasingly, there is acknowledgement of the overlappingnature of social identity groups, and psychotherapy re-searchers and practitioners are increasingly invoking the lan-guage of Bintersectionality^ and Bintersecting identities^ todescribe the ways in which individuals possess multiple socialidentities that cannot be attended to in isolation (Parent et al.2013; Nadal et al. 2015). In summary, though multiculturalcompetency was anchored in clinical practice with racial andethnic minorities, the concept has become a kind of umbrellaterm that encompasses multiple areas of social and culturaldifference, including LGBT issues and LGBT affirmativetherapy, as well as the knowledge, skills, and awareness nec-essary to intervene at systemic levels to bring about socialchange.

On the other hand, cultural studies scholarship has gener-ally suggested a critical perspective on multiculturalism, al-though this discourse remains largely absent fromBmainstream^ psychology. Cultural critics such as Ahmed(2006, 2012) have suggested that the institutional imperativeof multicultural inclusion has the twofold function of produc-ing an air of diversity while also maintaining the status quo.She has referred to this as the non-performativity of

antiracism, in which claims of institutional commitments todiversity shield those same organizations from critiques abouttheir lack of human cultural diversity and structural inequity.In other words, we say we are diverse and just, so we arediverse and just. Likewise, Melamed’s (2006) influentialcultural/historical analysis has linked multiculturalism to ra-cial inequality, among other dimensions of oppression (xeno-phobia, advanced capitalism). Melamed argues that multicul-turalism facilitates structural and institutional violenceinsomuch as deployments of diversity can actually perpetuateinequalities and explain away racialized economic disparitiesin terms of agency, markets, and choice (see also Melamed2011; Ferguson 2012). For example, the presence of people ofcolor in positions of power in institutions that are otherwiseracially stratified can symbolically obfuscate material inequal-ities and suggest that those who do not achieve economicsuccess have done (or not done) something to deserve theirsubordinate status. In the context of science and medicine,sociologist Epstein (2007) and others (e.g., Clarke et al.2003; Shim 2005) have argued that the mere inclusion ofwomen, racial and ethnic minorities, and sexual minority par-ticipants in biomedical research neither guarantees nor typi-cally results in a progressive transformation of scientificknowledge and practices. The logics of inclusion more typi-cally proffer opportunities for members of minoritized groupsto be incorporated into dominant systems as statistical out-liers, special interest groups, and potential niche markets—asopposed to being agents of radical social transformation(Duggan 2003). From this perspective, multiculturalism isnot progressive a priori, but is rather polymorphous: it pos-sesses a capacity for equity, redistribution, and justice, but it isnot essentially equitable, redistributive, or just (Brown 2006).

LGBTAffirmative Therapy in Practice

The APA (among other organizations) has rejected the useof so-called reparative or conversion therapies on thegrounds that the research supporting their use is minimaland flawed, and that there is no evidence that these ther-apies are safe or effective (APA Task Force onAppropriate Therapeutic Responses to Sexual Orientation2009; see Waidzunas 2015, for a critical history ofconversion therapy). The APA has instead supportedBLGBT affirmative^ therapy (Bieschke et al. 2007), andseveral theoretically driven articles have attempted to cod-ify its precepts (Harrison 2000; Goldfried 2001; Johnson2012; Pachankis and Goldfried 2013). Little research,however, has examined if and how LGBT affirmative ther-apy is actually taught to therapists, much less if and howit manifests in actual therapy sessions.

Accordingly, it is unclear what LGBT affirmativepsychotherapy actually Blooks^ like in psychotherapy

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sessions that deal with topics related to sexual orienta-tion and/or gender identity. Notably, one recent study ofthe experiences of LGBT individuals in psychotherapysuggests that psychotherapy involving issues related tosexual orientation does not appear to always beBaffirmative.^ Specifically, Shelton and Delgado-Romero (2011) conducted focus groups with 16 self-identified LGBT individuals about their experiences inpsychotherapy, focusing on these individuals’ experi-ences of sexual orientation microaggressions, or Bbriefand commonplace daily verbal, behavioral, and environ-mental indignities, whether intentional or unintentional,that communicate hostile, derogatory, or negative…slights and insults to [lesbian, gay, and bisexualindividuals]^ (Sue 2010, p. 5). Shelton and Delgado-Romero’s participants reported therapists assuming thatthe client’s sexual orientation was the source of theirpresenting problem, avoiding or minimizing discussionof the client’s sexual orientation, attempting to overidentify with LGBT clients, making stereotypical as-sumptions about LGBT clients, expressing a heterosexistbias (e.g., providing pamphlets and literature only onheterosexual relationships or concerns), assuming thatLGBT clients need mental health treatment, and warningof the Bdangers^ associated with identifying as LGBT.Although this study highlighted important aspects ofLGBT clients’ experiences in psychotherapy that maynot be considered Baffirmative,^ there is a lack of re-search on how LGBT affirmative psychotherapy is man-ifest in therapy sessions, the reciprocal relationship be-tween LGBT affirmative psychotherapy and LGBT psy-chological science, and the ways in which LGBT affir-mative practices are taught to trainees.

In l ight of rise of mult icultural competency(Ponterotto et al. 2009) and LGBT affirmative therapydiscourses in psychotherapy research and practice(Bieschke et al. 2007; Mallinckrodt 2009; Johnson2012), and the concurrent critiques of multiculturalismemanating from interdisciplinary cultural studies(Ahmed 2006, 2012; Melamed 2006), the release ofthe Alexander Street Press (ASP) training films catego-rized as being about Bsexual orientation^ in theCounseling and Therapy in Video (CTIV) series repre-sented a unique opportunity to examine not only whatprominent psychotherapists say about LGBT affirmativetherapy, but how they actually train other therapists toconduct LGBT affirmative therapy. Because these videospresent both lectures on LGBT psychology and actualand role-played therapy sessions, they serve to both de-scribe the research and theoretical literature on LGBTaffirmative psychotherapy and illustrate how therapistsand clients, themselves, co-construct the science andpractice of LGBT affirmative therapy.

Statement of Research Questions

The ASP training videos represent an important archive ofinstitutional discourse about LGBT affirmative therapy thatmight offer insight into how psychologists practice this thera-peutic approach, codify therapeutic principles, and attempt totranslate these skills to the films’ viewers, who are almostexclusively college and university audiences (E. Robey,2012, personal communication). As such, the following re-search questions guided our investigation:

1. How do these psychotherapists define Bsexualorientation^ and Bgender identity^? In constructing sex-ual orientation and gender identity, how do these videosreflect or challenge normative, culturally specific idealsof sexuality, gender, and mental health?

2. How do these videos connect sexual orientation and gen-der identity to other psychological issues? In constitutingsexual orientation and gender identity as components ofthe self, where and how do sexual orientation and genderidentity intersect or conflict with other social identities(e.g., gender, race, religion), sexual practices, and mentaldisorders?

3. What are the knowledge, awareness, and skills of a mul-ticulturally competent LGBT affirmative therapist?According to the videos, what does a competent LGBTaffirmative know, feel, and do?

Method

Sample

Data for this project were drawn from a database of trainingfilms that are part of the CTIV series published by ASP, whichincludes over 1000 hours of footage from 988 videos as ofAugust 2015. We chose this database as it represented a wide-ly available and accessible training tool at many trainingsites—approximately 425 colleges and universities own orsubscribe to Volume 1 of this database (T. Shondel, 2016,personal communication). We initially screened 1298 min offilms categorized under the subject heading of Bsexualorientation^ in early 2012 to inform our analyses. However,this is a dynamic database, and videos were added and re-moved during our analysis. Based on the videos available in2012 (see Table 1), we used theoretical sampling to create asubsample of 653 minutes of films to be subjected to the rigorsof grounded theory (GT; Corbin and Strauss 2008) by priori-tizing films that included actual therapy sessions, role-playedtherapy, and psychoeducational lectures by leading psycholo-gists, as well as films that explicitly addressed multiple dimen-sions of diversity. All films were produced since the year

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2000. (Note that ASP has added new sexual orientation- andgender identity-related categorizations to organize the videos(see Table 1). Some of the videos that were initially labeledunder the subject Bsexual orientation^ are categorized underdifferent subject terms in the database as it exists as of thewriting of this manuscript.)

Data Analysis

We employed a team-based, modified GT approach for ouranalysis. GT is distinct from other social scientific methodsbecause it is driven by exploratory questions, rather than hy-potheses, and is designed to generate explanatory theory fromthe data itself, rather than from extant theory (Corbin andStrauss 2008). Fassinger (2005) addresses the importance ofGT researchers coming to their data naïvely and without pre-suppositions, but she also accounts for realistic obstacles tosuch an approach: namely, that scholars typically have someexpertise in their research topics and so approach researchwith assumptions, as well as their identity-based standpoints.Though we did not have hypotheses or even evaluative opin-ions about these training videos, both authors did possessconsiderable expertise in this area prior to analysis. The firstauthor is an interdisciplinary social scientist who works at theintersections of psychology, sociology, and STS and isappointed in a counseling psychology program. The secondauthor was trained in an APA-accredited counseling psychol-ogy doctoral program and is currently appointed full-time inthe same counseling psychology doctoral program as the firstauthor. Both are White, cisgender, out queer men in their mid-30s who study the psychosocial dimensions of social inequal-ities, namely racism, sexism, and heterosexism in a US con-text. Both authors have conducted research on social justice,LGBT issues, and psychotherapy, as well as taught courses onapplications of social justice theories and principles in re-search and advocacy. However, we began the project withonly general knowledge of the psychological discourse onLGBT affirmative therapy, specifically, and were wholly un-familiar with the ASP video series.

In order to facilitate relatively organic analysis, we did notreview the literature on LGBT affirmative therapy whenconducting our initial analysis, open-coding video transcriptsand memoing in HyperRESEARCH (Hesse-Biber et al.2013). Only after developing extensive memos about eachvideo, reading each other’s memos, re-watching videos andre-reading video transcripts, and generating codes that appliedacross videos did we begin to Bread^ our codes across extantresearch in LGBT affirmative therapy. As opposed to consen-sual qualitative research (Hill 2012), our iterative analytic pro-cedures were not organized around reaching consensus; to thecontrary, we paid closest attention to moments in the videos inwhich we arrived at distinct interpretations. This processallowed us to engage in code-reduction and refinement, and

facilitated our understanding of the multiple potential mean-ings of the films. We did not employ formal data auditors perse, but we did present preliminary findings at several majorconferences (Grzanka and Miles 2012, 2013) and invitedtalks, and incorporated feedback from non-psychologicallytrained audiences, STS scholars, and psychotherapy experts.We did not enter the analysis with a focus on neoliberalism,but we were specifically interested in how the videos connect-ed sexual orientation to other dimensions of identity and men-tal health per our stated research questions above. Ultimately,we drew on cultural theories of neoliberalism, social studies ofpsychology, and recent critiques of the uptake ofBintersectionality^ in academic research and popular cultureto inform our analyses of the videos as we moved from thedescriptive stage to the theory-building stage of our research.Though the initial part of our analysis focused on understand-ing and describing the content of the actual therapeutic tech-niques advocated in the videos, our findings below focus onthe critical portion of our analysis: an emerging critique ofhow intersectionality is deployed in the CTIV videos aboutsexual orientation.

Findings

Therapeutic Sensitivity: A Gay Thing or a Me Thing?

The videos’ collective focus on identity introduces a key ten-sion between individual differences and group-based, struc-tural phenomena as determinants of clients’ life experiences.The informational lectures and therapy sessions convey infor-mation on topics relevant to LGBT populations, including thecoming out process, the impact of heterosexism on mentalhealth, and non-heteronormative family structures, and in sodoing, attempt to provide counselors and psychotherapistswith the requisite knowledge to conduct affirmative therapywith LGBT clients. In the process, topics such as coming outor dealing with homophobia are constructed as BLGBTissues.^ In Straight Privilege, for example, psychologistKathleen Bieschke explains how heterosexism shapes sexualminorities’ everyday lives, as well as the experiences and per-spectives of straight people. The film does not focus on ther-apy itself, but instead attempts to inform therapists about acompetency area—straight privilege—so that this knowledgeand awareness might translate intomore effective therapywithsexual minority clients. The implicit assumption of the videois that viewers themselves are straight and perhaps whollyunfamiliar with the concept of straight privilege and its con-sequences for social life. BI take my physical safety prettymuch for granted as a heterosexual woman,^ said Bieschke.BIf you’re gay, a lesbian, or a bisexual – depending on howthat’s manifesting – you put yourself at risks sometimes insociety and I don’t have to think about that.^ Bieschke posi-tions knowledge about heterosexuals’ unfair and unearned

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privilege as essential knowledge for working effectively withLGBT clients and for developing awareness (as conceptual-ized in the multicultural competency rubric).

Awareness and knowledge are distinct from actual thera-peutic skills and techniques, however. Bieschke does not in-struct therapists on when or how to deploy this knowledgewhen working with clients. Videos featuring actual therapysessions, on the other hand, [claim to] model best practicesfor working with LGBT clients, hypothetically linking skillswith knowledge and awareness of LGBT issues. InCounseling Gay and Lesbian People of Color: MultipleIdentities, psychologist Kevin Nadal and an actual client(i.e., not an actor), Juan Amaya, discuss Amaya’s feelings ofdepression. Though their session ultimately doesmove towardsexuality issues, Nadal does not presume that the presentingconcern is driven exclusively (or even primarily) by the cli-ent’s sexual orientation. With Amaya, an immigrant fromColombia, Nadal explores other aspects of identity (includingimmigrant status, ethnicity, gender, social class) and his familydynamics (e.g., what it was like expressing—or not express-ing—emotions in the client’s family). Their conversation—including both Nadal’s questions and affirmations andAmaya’s articulations of his feelings—introduce a tensionaround whether the source of the presenting issues is locatedwithin the individual or the environment. There is a multidi-mensionality to the therapist and clients’ discussion of socialidentity insomuch as Nadal wishes to highlight Bhow theseidentities sometimes conflict with each other…and sometimescan even complement each other.^ Simultaneously, however,there seems to be a distinction between identity-based issuesand the client’s broader sense of self. For example, whenAmaya discusses wanting a relationship and feeling isolatedfrom his friends and family, most of whom are straight, hesaid, BI don’t know if it’s just a gay thing or it’s a me thing.^When Nadal asks him to elaborate, Amaya says that he won-ders whether his failed attempts at relationships are the resultof his sexual orientation, personality, or Bme,^ suggesting acompartmentalized or fragmented sense of self that contrib-utes to his intermittent feelings of deep loneliness. Nadal doesnot resist or reject the clients’ framing, but continues to dis-cuss the various aspects of the client’s identity and relation-ships. Amaya’s sexuality continues to be positioned as part ofhim, but still distinct from his personality or Bme.^ They donot arrive at an answer to the question of Bwhether it’s a gaything or a me thing,^ but Nadal certainly does not insist oreven suggest that the answer to Amaya’s depression is rootedin conflict about his sexual orientation.

In Queer Theory in Action: Theoretical Resources forTherapeutic Conversation, Part One, psychologists JulieTilsen and David Nylund explain the principles of queer the-ory to a lay audience and then attempt to translate these prin-ciples into therapy. Their two videos illustrate how complexand seemingly esoteric academic theories can help clients

unpack assumptions about sexuality and gender as part ofthe therapeutic process. In Part One, Tilsen, and her client,Tighearnan, a transgender man of color, are discussing theclient’s challenging relationship with his mother. Tighearnanfeels that he and his mother do not understand each other—more specifically, that his mother cannot hear or will not listenwhen he expresses life goals and desires that are different fromhers. Tilsen asks Tighearnan what his mom would say if shewere there:

Tighearnan: That I just need to listen more.Tilsen: She would like you to listen more! And wouldshe say in your listening more that she would also comeinto understanding your similarities just as you wouldcome into understanding hers?Tighearnan: That’s what she would physically say, butwhat she would really mean… and maybe this is justhow I am interpreting it…that she would like me to bemore…she’d like me to do what she wants.Tilsen: Which is be a girl.Tighearnan: Hmm…be a girl. Go to college, focus onschool, live at home. Things that aren’t conducive to ahappy living environment for me.

This interchange illustrates one of the key tensions thatemerged early in our analysis. If the videos collectively sug-gest that LGBT affirmative therapy is a kind of multiculturalcompetency, then that implies their pedagogical objective is toprepare therapists to draw upon that competency during mo-ments in which the client’s presenting problem representssomething having to do with sexual orientation or genderidentity. Competency, then, represents not only knowledge,skills, and awareness, but also a therapeutic sensitivity: theability to dynamically deploy that knowledge when therapeu-tically appropriate. In this session, the therapist persistentlybrings the conversation around to conflict about identity andoppression, namely Tighearnan’s gender identity and transi-tion, going so far as to interrupt Tighearnan’s answer with theassertion that his mother wants him to be a girl. Tighearnan,meanwhile, directs the conversation toward his challengingrelationship with his mother, which he attributes to multiplereasons, including his decisions not to pursue higher educa-tionwhile living at home, which is of the utmost importance tohis immigrant mother, whom he views as resentful for havingsacrificed so much in her own life. While the therapist fore-grounds gender and sexuality issues, the client suggests thatcommunication problems are the key issue in his struggle withhis mother. On the one hand, Tilsen may be offering insight inthe form of BHave you thought about this before?^, i.e., help-ing Tighearnan to examine things about his relationships thathe has previously not considered. But in contrast to Nadal,Tilsen may also be demonstrating a determinist or essentialistapproach to LGBT affirmative therapy, in which the client’s

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social identities supersede all other factors in assessing prob-lems, conceptualizing mental health, and developing strate-gies for effective counseling. Such an approach would, ofcourse, be contrary to the aims Bqueer theory,^ which, asTilsen herself says, seeks to destabilize tacit notions of identityand undermine social and cultural systems that group individ-uals into arbitrary categories. Finally, though Tilsen and Nadaltake divergent approaches in their respective sessions, bothsessions share in common a sense that sexual orientation andgender identity issues complicate the self but are simulta-neously distinct from the self (e.g., a gay thing or a me thing),reinforcing the notion of person-environment tensions in cli-ent’s presenting issues.

Intersectionality as BMultiple Identities^

Multiple framings of intersectionality are present in most ofthe videos (explicitly and implicitly), though the concept isdeployed rhetorically in the linguistics of Bdiversity^ andBidentity.^ In Counseling Gay and Lesbian People of Color:Multiple Identities, for example, Nadal uses the phraseBidentity^ or Bidentities^ ten times, but does not use the termsinequality, oppression, discrimination, intersection, orintersectionali ty. Somewhat unsurprisingly givenpsychology’s historic focus on the individual, identity is theanchor through multicultural issues are illustrated and en-gaged. Nonetheless, the videos collectively emphasize themultidimensionality of identity. Rather than taking a Bsingle-axis^ (Crenshaw 1989) or sexuality-first (May 2015) ap-proach to LGBT issues, they reinforce an approach in whichidentity becomes identities, and the people who possess mul-tiple identities are people of color with other minority statuses,such as being poor, having a disability, being a woman, oridentifying as LGB and/or T. In Sexual Orientations inPerspective, for example, Linda Garnets underscores Botherareas of diversity^ and directly addresses multiculturalismthrough Crenshaw’s (1989) original intersection metaphor:

The discussion of intersections implies a charge to all ofus here today…it is essential that you who focus yourresearch and practice on other areas of diversity under-stand how sexual orientation fits into your work. Nosingle element of identity, be it race, ethnicity, class,disability, gender, or sexual orientation can truly be un-derstood except in relation to the others. We must usemodels that are based on multiplicity, not sameness.

Garnets charges multicultural psychologists (i.e., re-searchers and practitioners who focus on race and ethnicity)with attendance to sexual orientation issues and uses languageabout identity that sociologists Dill and Kohlman (2011) alsoevoke in their framing of Bstrong intersectionality^: the

examination of identities Bin relation to one another^ (p.169, emphasis in original). Nadal similarly asserts that it isimportant Bto understand how these identities sometimes con-flict with each other and sometimes can even compliment eachother.^ None of the videos suggest that LGBT individuals areexclusively defined by their sexual orientation and genderidentity.

Taken together, these videos suggest a psychotherapeutictheory of multiple social identities, but it is not always appar-ent if or how these identities are co-constituted or that allindividuals have multiple social identities. Bowleg (2012)suggested that the problem with the phrase Bwomen andminorities^ that pervades public health discourse is that itrelies upon an either/or logic in which women and racial/ethic minorities are imagined as discrete social groups thatcan be understood through the measurement and analysis ofcategorical variables. She stressed the relationality of identitycategories—a Bcore tenet^ of intersectionality that May(2015) called the Bboth/and^ impulse—in contrast to Beither/or^: race or gender, gender or class, for example. Althoughthese videos emphasize multiplicity, precisely how these iden-tities relate to one another is less obvious. For example,counseling psychologist Y. Barry Chung’s lecture inMulticulturalism in Psychology Education and Training em-phasizes the importance of moving beyond Bdiversity^ as de-mographic representation but offers multiculturalism as a the-ory that can transcend superficial identity politics. In compar-ing Bdiunital^ approaches to counselor education against race-based approaches to counselor education, Chung stresses howdiunital logic is rooted in a both/and impulse, as opposed torace-based models that frame multicultural issues in either/orterms. Nonetheless, he reaffirms an either/or conceptualiza-tion of identity by suggesting that (implicitly White) womenand (implicitly White) LGBT therapists might feel that aracial/ethnic issue is irrelevant to them, because it existsBoutside^ of their Bcomfort zone.^He suggests a similar fram-ing for racial and ethnic minorities:

So, what I’m advocating for is the people step out theircomfort zone and understand, emerge yourself and, andthat also applies to racial ethnic minorities. When there’sa session in training or class about sexual orientation orabout women, try to leave your comfort zone of racialminority and understand what it’s like to be a sexualminority. Only when that happens that we can have thediunital approach.

Elsewhere in his lecture, Chung references Bintersectional^collaboration, but once again frames minority groups in dis-crete terms, reflecting an either/or framework that has beeninstitutionalized in the field of psychology: BThe [AmericanPsychological Association’s] section on racial and ethic mi-norities and the section on lesbian, gay, bisexual concerns and

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the section for women…all of these would come together andfind ways that they collaborate and build awareness.^BIntersectional,^ in this use of the term, denotes across-group collaboration, not within-category diversity or necessar-ily structural inequality.

Psychologist Olivia Espin, on the other hand, speaks abouta structural understanding of intersectionality in her lecture ondeveloping a psychological perspective rooted in women ofcolor feminism. In fact, Espin begins her lectureoperationalizing the terms Boppression^ and Bprivilege,^r e j ec t i ng the no t ion tha t these a re Bt empora ryinconveniences.^ She explains that oppression and privilegecan be modified but are relatively permanent and beyond in-dividuals’ control. She uses the term Binstitutional^ and cri-tiques psychology for its focus on the individual to the neglectof the social:

To look at individual differences while ignoring powerdifferentials has been one of the marks of the field ofPsychology. In fact, Psychological theories that focus onthe person rather than the social context are still used asa tool to gloss over the impact of societal power struc-tures on the individual.

Citing Sigmund Freud, Karl Jung, and GloriaAnzaldúa, Espin offers a protracted critique of psychologyin the context of a video title Race, Gender and SexualOrientation: Counseling People with Multiple CulturalIdentities. Ironically, very little in the lecture is directlyabout counseling and sexual orientation, and she spendsmuch of the video discussing the centrality of religion toher own self-identity and to the psychology of culturaldifferences. Instead, she offers a structurally driven ac-count of social inequalities that is rooted both in socio-logical accounts of systemic inequality and personal lifehistory. In this sense, she echoes the tradition of womenof color feminists who inaugurated the study ofintersectionality (see Grzanka 2014), as opposed to thepsychologists who borrow the intersection metaphor todiscuss Bmultiple identities.^ Her emphasis on structure,lived experience, the interconnectedness of social catego-ries, and the simultaneity of privilege and oppression ismarkedly distinct from those who discuss identity catego-ries and social groups as defined by a primary dimensionof identity (e.g., Chung) or identities as things that some-times come together among multiple minoritized subjects(e.g., Nadal). Accordingly, we read her video as essential-ly critical of many of her peers, including the logic pre-sented in some of the other videos. Ultimately, the Beither/or^ problem of Bmultiple identities^ is not necessarilyimmanent to the way the field generally approaches issuesof identity and diversity, and Espin and Garnets’ workreminds us of the heterogeneity of approaches and

methods presented in these videos and represented in psy-chology more broadly.

BOutmoded Notions^ and the BNew Paradigm^:LGBTAffirmative Therapy as MulticulturalCompetency

Central to our analysis was the question of whether or not,according to these videos, LGBT affirmative therapy itselfconstitutes a novel, unique form of therapy, or a new approachor style of conducting therapy within established theoreticaland methodological traditions. Though not all the videosattended to this question explicitly, they did provide a collec-tive and consistent framing of LGBT affirmative therapy suchthat it represents a form of multicultural competency. In otherwords, the videos position LGBT affirmative therapy as amulticultural competency to be drawn upon as psychologistsdo their work in a wide range of settings (e.g., schools, privatepractice, teaching, training, research), but they do not constructLGBTaffirmative therapy as a particular kind of therapy, suchas cognitive behavioral therapy or psychodynamic therapy.

Instead of a novel set of therapeutic skills per se, the videoscharacterize LGBT as kind of paradigm shift (see Table 2).Garnets, for example, contrasts the Bold^ and Bnew^ para-digms accordingly:

The old paradigm put people into rigid categories ofheterosexual versus homosexual. In contrast, scientificresearch points to a new continuous multidimensionalconceptualization of sexual orientation….Until recently,those interested in the development of sexual orientationasked, BWhy do some people become gay or lesbian?^Today’s new paradigm expands this question to ask,BWhat leads all of us, heterosexual as well as LGBs, toform a particular sexual orientation?^

Garnets explains that the new paradigm embraces a multi-dimensional account of sexual orientation and gender identitythat rejects biological determinism but considers the role thatthe body plays in producing attraction. She attends to race andethnicity and invokes the language of intersectionality to de-scribe unique experiences of those whose Bdouble and tripleminority status^ may lead to feelings of inclusion and exclu-sion in multiple groups that represent their identities. TheBnew^ paradigm recognizes this complexity in both researchand practice, incorporating this knowledge and challengingextant beliefs and assumptions about sexuality and gender.For example, Garnets concludes by asking the audience ofpsychologists, BHow can you integrate this new paradigm ofcomplex and multidimensional sexual orientations that I’vepresented today into your work? This requires that each ofus change our outmoded notions.^ In this case, changing

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Boutmoded notions^ means exorcizing the homosexuality-pathologizing science that dominated the twentieth centuryand embracing the era of sexual orientation and gender iden-tity affirmation.

Psychology’s dominant rhetoric of Bcompetencies^ imbuesthese videos with a pedagogical agenda of elaborating andtransmitting knowledge, awareness, and skills about LGBTissues to viewers, and, in turn, Bmaking up^ or creating thisknowledge, awareness, and skills, similar to Hacking’s (1986,2002) suggestion that the interaction of scientists with thepeople they study changes and Bmakes up^ new categoriesof people. Though the introductory tone of the sexual orien-tation and gender identity content in these videos suggests thatthe imagined viewers are relatively naïve to these issues, thedelivery of the information fits firmly into discourse that fig-ures multicultural competency as a familiar set of skills fortherapists who may already have developed or are developinga sense of the role that ecological issues play on the phenom-enology of mental health. For example, in Lesbian, Bisexual,Gay, and Transgendered Counseling: Skill-Building Vignettes,school psychologists Stuart Chen-Hayes and Lynn Haley-Bañez offer six hypothetical scenarios in which parents andchildren are negotiating sexual orientation and gender identityissues at school and home, including dating, coming out atschool, and dealing with bullying and harassment. In this vid-eo, the emphasis is less on personal exploration and more onnegotiating difficult environments for LGBT youth and theirparents (some of whom are also LGBT). The persons in thescenarios are racially, ethnically, and religiously diverse andinclude an interracial lesbian couple, a Caribbean Americanfamily, a Chinese American gay youth, and an OrthodoxJewish father of a gender nonconforming son. Whereas inNadal’s video the client (Amaya) has apparently internalizedhis romantic insecurities as coming from himself (i.e., Ba mething^), the skill-building vignettes shift the focus from theclients’ problems to the clients’ environment. The counselorsfunction as consultants and as psycho-educators, facilitatingparents’ and youths’ acquisition of information, resources,and support to negotiate their socio-environmental challenges.Though these vignettes represent multiple dimensions of dif-ference, it is still apparent that what makes an issue an LGBTissue is the sexual and gendered nature of these conflicts. Forexample, the Black parents who are struggling with theirdaughter’s sexual behavior (e.g., apparently dating other girls)discuss their ethnic-religious identity (e.g., the father is aRastafarian and the mother is West Indian), but neither theiridentities or beliefs, nor their daughter’s are positioned asproblematic or pathological. In this sense, part of beingLGBTaffirmative also means affirming the feelings of hetero-sexual parents struggling with their own feelings ofhomonegativity, including their feelings of loss over theirdaughter’s formerly assumed heterosexuality, as displayedby the counselor:

I really appreciate you sharing that ‘cause it sounds likethere’s tremendous amount of fear underneath the angerabout, Bwhat kind of a life is she gonna have?^You havethese wonderful hopes and dreams for her, career-wise,academics. But it sounds like your image of her, in termsof your daughter, it’s like the picture frame, the picturehas shattered…and so at this point I encourage you all topick up the pieces together as a family unit. And I cantalk with you and help you talk with each other aboutthat.

Rather than pathologize, the counselor offers to facilitate adialogue between daughter and parents so that all of them cancome to terms with her sexual identity, and he suggests thatthe parents reach out to the local PFLAG (formerly Parentsand Friends of Lesbians and Gays) group for social support.The counselor anchors the conversation in addressing the par-ents’ feelings of isolation, which are at least partially due totheir ethnic and religious traditions’ relationships to non-dominant sexualities, but his multicultural competency is root-ed in providing information about sexual orientation issues.Presumably, he counsels as he would with any other parents—facilitating dialogue, providing resources—but his competen-cy in LGBT affirmative therapy is based in his knowledge,skills, and awareness of LGBT issues. LGBTaffirmative ther-apists affirm LGBT identities, and they think about these iden-tities in terms of other identities, namely race and ethnicity.

Discussion

We conclude that LGBT affirmative therapy does not consti-tute a revolution in therapeutic practice, at least as articulatedby these videos produced by leaders in the field and by psy-chological research that has attempted to codify LGBT affir-mative therapy’s defining attributes (e.g., Bieschke et al. 2007;Johnson 2012). However, LGBTaffirmative therapy does rep-resent a meaningful shift when compared with the earlier erasof what we call pathologization and inclusion (see Table 2),and what Hammack et al. (2013) suggested were master nar-ratives of Bsickness^ and Bspecies.^ In constructing our con-clusions about the era of affirmation, we used the iterative,interpretive process of grounded theory to help us describeand then theorize on the content of the videos in terms ofour exploratory research questions. Key themes that emergedfrom our analysis include therapeutic sensitivity, multiple so-cial identities, and multicultural competency. Though our ini-tial interest in the video archive was primarily descriptiveinsomuch as we wanted to know how these therapists opera-tionalized LGBT affirmative therapy with the expressed pur-poses of training other (future) therapists, we were drawn tomore critical concerns about the place of social identity—namely, the articulation of intersectionality as Bmultiple

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identities^—and the epistemic politics of incorporatingBLGBT issues^ into traditional approaches to psychotherapy.

Although resisting pathologization may seem common-place and obvious to scholars in LGBT studies, these videosdo illustrate how the affirmative, multicultural turn constitutesa meaningful and consequential shift in therapeutic training,research, and practice in psychology. As we read our findingsacross contemporary discourse on LGBT affirmative therapy,we found a consistent insistence on LGBT affirmativetherapy’s necessity as a form of competency that therapistsshould learn and deploy in their everyday work with clients.For example, Harrison (2000) suggested that there is a Bgayaffirmative approach^ to therapy with distinguishing charac-teristics that reflect awareness, knowledge, and skills aboutsexual orientation issues. Similarly, Johnson (2012) arguedthat gay affirmative therapy is a therapeutic approach, not aspecific psychotherapy in and of itself. Landridge (2007) dis-tinguished between two kinds of BLGB affirmative therapy^:Bstrong^ versus Bethically affirmative.^ Whereas ethically af-firmative therapy means essentially doing no harm to LGBclients, Bstrong^ approaches are characterized by activelycombating heterosexism in the therapeutic alliance. ThoughJohnson (2012) acknowledges that there may be a need forpopulation-specific interventions, he concludes that gay affir-mative therapy is synonymous insomuch as affirmative ther-apists must show understanding, demonstrate cultural compe-tence, and create a positive therapeutic alliance—all of whichare essentially characteristics of a good therapist. Finally, inthe introduction to the second edition of the APAHandbook ofCounseling and Psychotherapy with LGBT Clients, Bieschkeet al. (2007) position their volume as doing the work ofBdefining^ LGB and T-affirmative therapy into a set of bestpractices and competencies. The videos we studied reflect andcomplement these assertions, sketching the qualities of anLGBTaffirmative therapist to whom privilege and oppressionare key therapeutic constructs, inequalities are approachedwith sensitivity to their multidimensional complexity, andmultiple social identities are foregrounded.

Incorporating Intersectionality or Intersectionality,Inc.

Intersectionality is integral to our analysis as it has emerged asa framework in which multicultural psychology has attemptedto articulate the complexity of social identities in the late twen-tieth and twenty - first centuries. We are inspired by Bowleg’s(2012) critique of public health discourse, however, to suggestthat multicultural psychology may have an unintendedBproblem^ of/with the concept Bmultiple social identities^ asit has become a dominant rhetorical structure for addressingintersectionality (see also Bowleg 2008). Robust scholarshipin intersectionality studies has wrestled with the complexity of

intersectionality (McCall 2005), positioning intersectionalitynot merely as a method or theory, but as what Cho, Crenshaw,andMcCall (2013) identify as an Banalytic disposition.^ Theirconceptualization of intersectionality as a way of approachingthe relationships among systems of domination with the goalof understanding and resisting co-constitutive forms of op-pression is theoretically and politically consonant withLGBT affirmative therapy as represented in these videos.However, we found that these videos primarily articulatedintersectionality in terms of identities, not in terms of structur-al inequalities.

We and others (e.g., Dill and Kohlman 2011; May 2015)argue that a structural critique sits at the center ofintersectionality theory and US Black feminist thought morebroadly. A focus on structure encourages scholars, practi-tioners, and activists to re-orient attention away from identityin and of itself and toward identities in structural context—identities in relationship to the systems of power that engenderthem. For example, Carbado (2013) has asserted that:

Intersectionality reflects a commitment neither to sub-jects nor to identities per se but to marking and mappingthe production and contingency of both. Nor is the the-ory an effort to identify, in the abstract, an exhaustive listof intersectional social categories and to add them up todetermine—once and for all—the different intersection-al configurations those categories can form. (p. 815)

Similarly, as Grzanka (2016) noted, MacKinnon (2013)rejected an identitarian framing of intersectionality by sug-gesting that stereotypes and social classifications are theBossified outcomes of the dynamic intersections of multiplehierarchies,^ rather than the causes of systemic inequalities (p.1023). And yet the focus on Bmultiple identities^ in many ofthese videos reflects psychotherapy’s attention to individualsubjects and the parsimony and independence of social cate-gories, a symptom or residue of psychology’s dominant epis-temology (Goff and Kahn 2013; Syed 2010; see also Grzanka2016). The pervasiveness of intersectionality-like orintersectionality-lite discourse in many of these videos raisesconcerns about what others have referred to as themainstreaming or cooptation of intersectionality across insti-tutional discourses that sometimes has the effect of simplify-ing or depoliticizing its most potent analytic and political am-bitions (Davis 2008; Luft and Ward 2009; Dhamoon 2011).For example, though the capacity of therapists to engage insystemic-level interventions is a core component of multicul-tural and social justice competence (ACA 2015), none of thesevideos illustrate how this might actually occur. Instead, theyretain a focus on the individual client and therapist, dyad, orsmall group (e.g., a family), as opposed to an organization,institutional, or societal level. We believe that it is imperativefor psychotherapists to move beyond rhetorical gestures about

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social justice work and to actualize long-standing calls foradvocacy work beyond the walls of the therapy room(Toporek et al. 2006; Speight and Vera 2008). Prior researchon intersectional activisms has consistently demonstrated thatcoalitional work that targets oppression itself—as opposed tonarrowly defined identity categories—is necessary for institu-tional transformation (e.g., Cole 2008). Moving beyond therecognition of intersecting identities will require re-considering the multiple roles psychotherapists may occupyin their professional and personal lives, and may also involveshifting the locus of expertise away from the psychologist andtoward the underserved, multiply marginalized communitieswho should inform multicultural competencies. Because wecannot anticipate all potential intersections of oppression, wemay also consider the relevance of what Owen and colleaguescall multicultural orientation: not a set of knowledge, skills, orawareness, per se, but a sustained responsiveness to clients’(and therapists’) cultural differences and needs—even whenthese needs may challenge established scientific principlesand best practices (Owen et al. 2011).

Based on our analysis of the CTIV videos and the attendantpsychological literature on LGBTaffirmative therapy, we sug-gest that at least elements of what we call psychology’sBmulticultural turn^ are actually consonant with neoliberaltransformations of social and institutional life that foremostfunction to incorporate difference, rather than to redirect andreconfigure the ways power and material resources are unfair-ly distributed (Grzanka et al. 2016). Cultural critiques of neo-liberalism have focused on how market logics and principlesof unfettered capitalism have influenced spheres of social andcultural life typically conceptualized as beyond or outside thescope of the economic (Duggan 2003; Grzanka and Maher2012; Grzanka and Mann 2014). We are not suggesting thatpsychotherapy broadly or LGBT affirmative therapy is funda-mentally neoliberal, but we do suggest that interventions thatfocus on individuals always possess the capacity to place re-sponsibility for health and well being on individual agents(Adam 2005; Ahmed 2010; Mann 2013; Elliott 2014;Davies 2015). Rather than conclude finally about LGBTaffir-mative therapy’s relationship to neoliberalism, we posit ourcritique as a provocation to further sustained empirical inqui-ry. What if the rise of multiculturalism in applied psychologyis not simply a departure from business-as-usual, thoughmuchof the content of multicultural psychology is obviously dis-tinct from the work that precedes it? What if, as Foucault(1978) anticipates, such an apparently liberatory turn wereactually part of a larger choreography of scientific knowledgeand practices that complement rather than resist hegemonicsocial forces. Could the assent of LGBT affirmative psychol-ogy—which represents a seemingly radical reversal in thecourse of a discipline that spent most of the twentieth centurydocumenting homosexuality’s uniquely pathological perver-sions—be an integral part of the management of difference as

opposed to a form of resistance external to psychology’s dom-inant pedagogy?

If we take seriously the robust scholarship that critiquesneoliberalism, especially its cultural dimensions, then weshould critically consider psychology’s multicultural turn andat least entertain some ideas about howmulticulturalism, diver-sity, and—increasingly—intersectionality have beenconstructed and weaponized in the name of what Duggan(2003) termed BEquality, Inc.^: a stripped down, non-redistributive form of identity politics whose hallmarks areincorporation, representation, and integration, as opposed tosocial justice movements that demand radical deconstruction,reformation, and redistribution of power and resources. One ofthe most meaningful contributions of queer and intersectionalcritiques of neoliberalism has been to illuminate how multicul-turalism itself has become a neoliberal technology of socialdomination (Ahmed 2004, 2012; Reddy 2005; Brown 2006;Ferguson 2012; Wiegman 2012). Being included, made visi-ble, accounted for, and institutionally recognized on the basison one’s difference has not generally accompanied institutionaltransformation, or even delivered on the promise of equal rep-resentation. Melamed (2011) and Reddy (2011), for example,have argued that representation in neoliberalism is quintessen-tially violent, and Gray (2013) has recently suggested that rep-resentational politics have facilitated neoliberalism’sfetishization of difference in the interest of universal commit-ments to individual liberty, market choice, and agentic concep-tions of equality. He argued that Bincreased visibility and accessto representation can engender new forms of subjection andmarginalization^ (p. 791). Gray also theorized that BAs withthe regime of sexuality that resulted in the incitement and pro-liferation of talk about sex, I venture to say that in neoliberal-ism, identity organizes and deploys this discourse of differenceof which the quest for recognition and visibility is an effect^ (p.790). Similarly, we express concern that if multiculturalism inapplied psychology is organized foremost around a politics ofvisibility and inclusion, this may likewise engender new formsof subjection and marginalization even as such discourse ismotivated explicitly by a Bsocial justice^ imperative.

Limitations and Implications

These videos raise many more questions than answers about thestate of LGBT affirmative therapy in the contemporary psycho-logical science, and our analysis of them is inherently limited inseveral meaningful ways. First, our study focuses on therapist-training materials and privileges therapy itself over other profes-sional activities, including research, political work, and policyadvocacy, that are presumably part of many LGBT affirmativetherapists’ lives outside of the therapy room. Second, textualanalysis tells us nothing about how these videos are being under-stood by viewers, or deployed pedagogically by instructors. The

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next step in our research is to interact with the videos’ users—both trainees and instructors—to see how they make meaningout of these videos and what kinds of knowledge, skills, andawareness they engender. Where do these videos fit into theirtraining programs? Are they used as examples of best practices,supplementary material, or something else entirely? How arepsychologists using (or not using) these videos to cultivate notonlymulticultural competencies, but the therapeutic sensitivity toemploy these competencies effectively in therapy? Are theremeaningful differences in the ways in which school, counseling,and clinical psychologists conceptualize and train LGBTaffirma-tive therapists? Furthermore, we did not analyze all videospertaining to LGBT issues in the CTIV series as the databasewas continually growing and changing throughout the durationof our study. For example, the videos we analyzed did not attendto important questions about the persistence of transgenderpathologization in the fifth major revision of the Diagnosticand Statistical Manual (American Psychiatric Association2013). However, the database now includes a 2013 video byNadal that may do so (Counseling Transgender People: ThreeDemonstrations). A major concern of transgender scholar-activists has been the conflation of trans issues with LGB andsexual orientation issues that are related but nevertheless distinct (Fassinger and Arseneau 2007; Burnes et al. 2010; Byne et al.2012). Our sample of videos reinforces this concern, but futureLGBTaffirmative therapy training videos may more fully exam-ine trans issues independent of those facing LGB cisgender in-dividuals. Additionally, our positionality in the US and in anAPA-accredited counseling psychology program inevitably in-fluences our data interpretation and the literatures we draw uponin ways that are likely more obvious to scholars outside the USthan they are to us.

As the state of LGBT psychology is rapidly changing, weanticipate ongoing transformations in the ways that psychol-ogists define and professionalize LGBT affirmative psychol-ogy. The videos we analyzed were neither mono-vocal noruni-dimensional in their approaches or conceptualizations ofLGBT issues, and our purposively derived sample is not nec-essarily representative of the entire CTIV database. For exam-ple, Espin’s lecture foregrounded structural issues and delin-eated a theory of intersectionality that is consonant with wom-en of color activism that takes society—not the individual—asits object of critique. Similarly, Garnets’s lecture engaged notonly the content of LGBT psychology but the concept ofparadigms, suggesting that both practical and epistemologicalissues are at stake in the incorporation of sexual minority andgender nonconforming clients into the mainstream of the field.How these epistemic and pragmatic concerns are manifestingin actual mental health service provision is a fundamentallyempirical question.

Intersectionality theorist Collins (2014) has asserted thatthere is no fundamental link between intersectionality andneoliberalism. In an address at the first international

conference on intersect ional i ty, she argued thatintersectionality has proliferated in contemporary multicultur-al discourse across disciplines and organizations in ways thatconflate intersectionality with Bcelebrating diversity.^ Thiskind of multiculturalism, according to Collins, collaborateswith neoliberalism by divorcing intersectionality from politicsand incorporating it into oppressive structural contexts with-out demanding restitution and radical re-configuration ofthose systems. Echoing Duggan (2002, 2003), Brown(2006), Spade (2015), and others’ long-standing critiques ofBliberal^ rights discourse, such demands for full representa-tion and participation in exclusionary and historically violentsystems such as marriage, the military, privatized healthcare,the global capitalist economy, and even mental health servicesare antithetical to intersectionality even as they invoke rhetoricthat sounds like intersectionality. Rather than challenging op-pressive structures, calls to claim a Bplace at the table^ (e.g.,Bawer 1993; Hendricks 2014) serve to collude with and per-petuate these structures. This highlights Collins’s (2014) fram-ing of the paradox of neoliberalism and intersectionality.There is nothing inherently wrong with focusing on identity,as so many of the psychologists in the CTIV database do;moreover, there is nothing about intersectionality that rejectsthe concept of identity. Nevertheless, multiculturalpsychology’s proliferating discourse on intersecting and mul-tiple identities may work in the service of neoliberalism oragainst it. Psychology’s disciplinary anchor—the individu-al—constitutes a kind of epistemic riptide: the self is thestarting point, and runs the inherent risk of being the end point.Likewise, the self is perhaps neoliberalism’s key unit of anal-ysis, and a mentally healthy self who understands herself interms of diversity is not antithetical to neoliberalism at all, solong as takes her rightful place as the responsible social actoror homo oeconomicus (Bay-Cheng et al. 2015). We encouragepsychologists to actively seek dialogue with clients, activists,and non-psychologists that may help the field resist a tacitconstruction of multiple identities. In complicating racist, sex-ist, and colonialist ontologies of the self,multiple, intersectingidentities exemplifies the era of affirmation’s Bnew^ way ofthinking about the self, inequality, and mental health thatpromises to represent members of multiply marginalized so-cial groups in fair(er) and just ways. The persistent question iswhether LGBT affirmative psychotherapy can do Bmultipleidentities^ without returning to neoliberal framings of the selfthat define personhood by markers of difference that are al-ready coopted by institutions and practices designed to, asMelamed (2011) would put it, destroy them.

Compliance with Ethical Standards

Funding This research was supported by a collaborative grant from theNational Science Foundation’s Science, Technology, and SocietyProgram (award numbers 1229874/1229867). We would also like to

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thank audiences at Drexel University and the University of SouthCarolina for their helpful feedback on earlier versions of this manuscript.

Ethical Approval This article does not contain any studies with humanparticipants or animals performed by any of the authors.

Conflict of Interest The authors declare that they have no conflict ofinterest.

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