Ellyn Bader

Although I have always enjoyed doing couples work with gay men, I am hardly a specialist in this area. So at times when I’ve had questions I’ve turned to my colleagues Rick Miller and Clinton Power. Rick’s practice in the Boston area specializes in work with gay men and Clinton’s in Sydney serves the LBGTQ population.

So for this month’s blog, I reached out to Rick and Clinton to help readers who work primarily with heterosexual couples and want to expand your knowledge base for helping gay men. I’ll start with some of Rick’s insights on common issues for gay male couples and follow up with a set of questions from Clinton that open communication lines and pave the way for your work.

Rick Miller has been a popular presenter at the annual Couples Conferences that we co-sponsor with the Milton Erickson Foundation. Last year his presentation was framed around potentially difficult conversations a therapist might initiate with gay couples in the areas of sex, money and vulnerability.

I know from my own practice and also from the many cases therapists have brought to me for consultation that these issues can be especially challenging to heterosexual therapists working with gay couples. So I am pleased to share Rick and Clinton’s information with you.

Rick repeatedly stresses the challenge for men of being vulnerably expressive with one another. Being independent and strong comes so much more easily than acknowledging what might be viewed as softer emotions. Western culture supports strength in men and belittles deep internal vulnerability or insecurity.

This is compounded by the internalized shame carried by most gay men. Imagine the challenge of growing up having to hide feelings of love and sexuality and knowing those feelings are unacceptable – even dangerous – in the larger culture.  Gay men face disapproval or worse if those emotions are visible. Being able to hold men in those vulnerable feelings is a core skill for your couples sessions to work.

Rick also emphasized the necessity of being able to talk explicitly about sex. So many common sexual myths exist. For example:

  • No gay couples are monogamous
  • Gay couples don’t have sexless relationships
  • All gay men like anal sex
  • Gay men don’t have erection issues

He suggested opening the topic of sexuality with some initial questions.

  • Are you open or monogamous?
  • How often do you masturbate?
  • Do you use porn-alone or together?

Rick also asked heterosexual therapists to challenge their own biases about open relationships and hook-ups.

In addressing financial issues, Rick suggested noticing who is paying for therapy and why. And do they have any joint checking accounts? Why or why not?

Have they fallen into specific rolls around who provides financial support and who does chores and housework? Were these agreed to or accidentally structured? Is this adding to stress in the relationship?

Rick has observed in his practice that open relationships work best with the following structure:

  1. The partners agree about open relationships that are either sexual, romantic or both.
  2. They have similar reasons for opening their relationship.
  3. They agree on guidelines that they respect and keep.
  4. They communicate openly and actively with one another and especially if they stretch beyond their agreements.

Clinton’s Questions

I recently asked Clinton Power to give me a list of questions that heterosexual therapists might not know to ask gay couples. Here are some excellent questions he gave me for your consideration.

  1. How comfortable are you with showing affection to each other in public, such as holding hands, kissing, hugging, or acknowledging publicly you're a gay couple?
  2. Do you have preferred sexual roles? Who's top, who's bottom, or are you versatile? And what role does this play in your relationship? Are you happy with how this works or is it an issue in your relationship? Would you like to discuss that here?
  3.  Do you have a monogamous, open, or polyamorous relationship? If open or polyamorous, what agreements, if any, have you made around negotiating sex with others? How well do these agreements work for each of you?
  4.  Are you both out to friends and family? If not, who is not out and how is it impacting on your relationship and your personal happiness? If you are out, what was the reaction of family and friends? What impact has coming out had on your life?
  5.  Do you have a joint will or estate planning, or separate wills? Have you discussed what will happen when one of you dies before the other? Do you have financial power of attorney? Do you have joint bank accounts or credit cards? If not, why not?

I’m grateful to Clinton and Rick for their help. For more information you can contact Clinton at  www.sydneygaycounselling.com and Rick at www.rickmiller.biz.

Meanwhile, I’d like to tell you about a resource that’s helpful for almost every couple in your practice. Stepping Stones to Intimacy introduces couples to the stages of relationships. It explains and normalizes many challenges that couples face. The brochures are sold in packs of 25 so you can give them to your couples. Click here to learn more or order.


Ellyn Bader, Ph.D., is Co-Founder & Director of The Couples Institute and creator of The Developmental Model of Couples Therapy. Ellyn is widely recognized as an expert in couples therapy, and since 2006 she has led innovative online training programs for therapists. Professionals from around the world connect with her through internet, conference calls and blog discussions to study couples therapy.

Ellyn’s first book, "In Quest of the Mythical Mate," won the Clark Vincent Award by the California Association of Marriage & Family Therapists for its outstanding contribution to the field of marital therapy and is now in its 18th printing. She has been featured on over 50 radio and television programs including "The Today Show" and "CBS Early Morning News," and she has been quoted in many publications including "The New York Times," "The Oprah Magazine" and "Cosmopolitan."

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A Glossary of Terms that are sometimes Confusing

Couples Therapy is a counseling procedure that seeks to improve the adjustment of two people who have created an interdependent relationship. There are no standard procedures to help two people improve their adjustments to each other. Generally, a more experienced therapist will offer more perspectives and tools to a couple. Length of treatment will depend on severity of problems, motivation and skills of the therapist. A couple can be dating, living together, married or separating and may be gay, lesbian or heterosexual.

Marriage Therapy is a term often used interchangeably with marriage counseling. The term marriage implies two people have created a union sanctioned by a government or religious institution. The methods used in marriage counseling, marriage therapy and couples therapy are interchangeable and depend more on the specific challenges of each unique couple.

Psychotherapy is one or more processes to help improve psychological and emotional functioning. Examples are psychoanalysis, cognitive therapy, behavior therapy, Gestalt therapy, Transactional Analysis, Rational-Emotive therapy, or group therapy. Many forms of psychotherapy are blends of different approaches. For example, newer forms of psychotherapy called energy psychology draw upon recent advances in brain and neuroscience. These approaches often build on cognitive behavioral methods.

Clinical Psychologist. After graduating from college, it usually takes about five years of graduate school to get a Ph.D. in Psycholgy. It then requires an additional two years of supervision and passing a written (and often) an oral exam. There are a few states that allow psychologists to prescribe medications (with additional training) but that is uncommon.

Psychiatrist. After graduation from medical school, there is a generally a 4-year psychiatric residency. After the completion of this training, psychiatrists must pass an exam issued by the American Board of Psychiatry and Neurology to obtain certification and legally practice in the field. Psychiatrists can prescribe medications.

Clinical Social Worker. This profession usually requires two years of study after obtaining an undergraduate degree. While specific licensure requirements vary by state, most require clinical social workers to obtain 3,000 hours or 2 years of supervised clinical experience, after obtaining a Masters degree. Social workers can also specialize in diverse fields such as human services management, social welfare analysis, community organizing, social and community development, and social and political research.

Marriage and Family Therapist. Obtaining this license requires a Masters degree which takes approximately two years of post graduate study. The license also requires 3000 hours of supervised work and passing written exams.

The Couples Institute. We have assembled a group of top notch therapists at The Couples Institute. Whatever marriage help or marriage advice you are looking for, we are here to serve you. While most other therapists see only a few couples a week, we specialize in marriage and couples relationships, working to develop and bring you the most current and effective approaches to couples therapy. For more information about couples therapy or marriage counseling, see our couples therapy section.

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Pete Pearson
Pete Pearson
3 years ago

These are great questions that heterosexual therapists may not think about in gay relationships. I think evidenced-based approaches don’t take the perspective of specific situations like specific challenges of the gay, lesbian etc communities.
Thanks for the invited responses from other experts.

3 years ago
Reply to  Pete Pearson

Yes Pete, I think many therapeutic approaches take a narrow mindset and assume social structures that do not apply to everyone, including the LGBTTQ+ communities. (Little tip: the full acronym – or at least a more robust attempt, cause the acronym certainly fluctuates – is a really lovely thing to incorporate into your language. No one wants to see themselves as the ‘etc.’!)

Ephraim Frankel
Ephraim Frankel
3 years ago

Thanks Ellyn, Clinton and Rick. This offering is illuminating and reassuring. I like how the conversations are being opened up and expanded; and, that previously neglected or suppressed issues are now seeing the light of reality honesty and authenticity.
I also appreciate how much the energies and commitments of the Differentiation Principle empower all partners to live more vibrantly and more intimately.

Jean Pollock
3 years ago

Terrific questions. Thanks for sharing Clinton and Ricks’s work. I’ve started asking straight couples whether they’d define their relationship as open or monogamous as well.

3 years ago

I appreciate that this article begins to open up potentially hidden issues in gay male partnerships, and to dispel myths about such partnerships. I noticed, in this exploration of those issues, that there may be some implicit myths about heterosexual partnerships that could use some attention! 🙂

1) It is indeed a myth that gay partnerships do not all operate within an open or polyamorous structure. If “Assuming Nothing” is not something you are already in the habit of doing, it could suggest that you are operating on the incorrect assumption that heterosexual couples are automatically monogamous and do not need this question asked of them. (Thanks to Jean Pollock who noted this in their comment!)

2) A couple thoughts on sexual roles: Firstly, variation in sexual roles is not unique to gay male partnerships. Heteronormativity is harmful to your clients that present as heterosexual/cisgendered, and shuts the invitation for them to express invisible creative/alternative gender identities (and how that manifests sexually /romantically/ socially), explorations and expressions of kink, and non-normative expressions of masculinity and femininity. Second, if your gay male clients identify as tops or bottoms, kindly do not assume that top = dominant and bottom = submissive. Apart from the fact that every person enmeshes with these identities differently, there are also nuances here that can only be known by inviting your client to share more than just this label. A simple example: one can be a submissive top, or a dominant bottom. Fun right? 🙂

3 years ago
Reply to  Liana

About my own comment – a MAJOR TYPO!!

“It is indeed THE TRUTH that gay partnerships do not all operate within an open or polyamorous structure.” Yikes!!

3 years ago

Do queer people fall into rolls? I have an image of the dough boy. Replace with roles, bake for 25 mins at 350!

Jan Frigo
Jan Frigo
3 years ago

How Can I Read the Content of the Stepping Stones Brochure prior to purchase. I don’t know if I would use it in my private practice unless I can read it first.
The questions are helpful.

Robert Grimes
Robert Grimes
3 years ago

I see no difference with hetero or gay with all the info and questions supplied in this article. There are roles, lack of vulnerability, sexual issues, shame, open or monogamous in all intimate love relationships. I think this is more about how comfortable a couple counsellor is with whatever relationship dynamics that are present with the couple. I see both hetero and gay couples and I don’t treat them any different however, as I am gathering info and assessing, I will ask questions relevant to that couple.

Clinton Power
Clinton Power
3 years ago

Thanks for inviting me to comment, Ellyn! I too see a lot of similarities between working with straight and gay couples, but the main difference in the gay male couples I work with is they often place a lot of importance on sex and present for therapy when there are sexual problems, betrayal issues, they want to explore and negotiate some form of non-monogamy, or a non-monogamous arrangement is not working. They are a great population to work with. I hope your community found my questions helpful.

1 year ago

Any advice on how to *find* that partner later in life? How do I know what I want in a partner now that I’m 62 and alone again?

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