How do gay men experience ruptures in the relationship with their therapist? : an interpretative phenomenological study

Rationale: There is a higher prevalence of mental health problems for gay men, who experience higher rates of depression, substance misuse problems and suicide. Gay men use therapy at higher rates than the general population, but are also more likely to report unsatisfactory experiences in therapy - otherwise known as ruptures. There is a lack of research not only on the client perspective of ruptures but also within specific minority groups such as gay men, and therefore it remains unknown how they experience ruptures in therapy. This study aims to offer insights into this area to deepen understanding and produce new knowledge about whether the experience of ruptures in the therapeutic relationship is different for gay men and, if so, how. Methodology: Interpretative phenomenological analysis was used to explore seven gay men's experiences of ruptures/difficulties in the relationship with their therapists. Data was gathered using semi-structured face-to-face interviews. Findings: The analysis yielded three master themes: 1) The origins of the rupture: therapist as invalidating threat to gay identity and self, 2) Rupture as process of struggling to defend gay identity and the self, and 3) Negotiating reparation and/or closure of the rupture. The key finding was that participants attributed the cause of the rupture to therapist homophobia and/or lack of therapist understanding on gay issues, which presented additional barriers to the therapeutic process, and meant that participants edited out aspects of their gay identity in therapy. The study also found that rupture overlaps with the difficulties commonly experienced as part of the therapeutic process, making it difficult to define rupture. The researcher links the findings to minority stress theory, and suggests that an over-emphasis on the transferential relationship in therapy, and rigidity in therapeutic approach, can impede the collaborative process that is more likely to lead to reparation with this client group, especially when they are at an early stage in their gay identity development. The findings indicate that participants' rupture experiences are compounded by both projections of their internalised fears of homophobia onto their therapist and a lack of therapist understanding of the therapeutic needs of gay men. The limitations of the study are discussed, and the implications for practice, research and training are discussed in light of the findings.