Experiences of disclosing sexual orientation in healthcare consultations Emma Louise Berkman-Smith Submitted in accordance with the requirements for the degree of Doctor of Clinical Psychology (D. Clin. Psychol.) The University of Leeds Academic Unit of Psychiatry and Behavioural Sciences School of Medicine September 2011 The candidate confirms that the work submitted is her own and that appropriate credit has been given where reference has been made to the work of others This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. 2 ACKNOWLEDGEMENTS I’d like to thank my supervisor, Dr Carol Martin for her support and guidance throughout this process, Dr Bonnie Meekums and Dr Gillian Proctor for their help in the initial stages. I would particularly like to thank the University of Leeds LGBT Society and Gay Leeds for taking it upon themselves to advertise this research and encouraging people to participate. I must also thank everyone who contacted me about the study; those who participated and those who felt that the study was not for them. Most of all thank you to the people around me who have made it possible for me to complete this. My wife has borne the brunt of this burden, she has lived with a troll-like creature for many months now and her patience and love have been essential. H, thank you I promise to be much nicer to live with now! 3 ABSTRACT This study focused on experiences of healthcare consultations for lesbian, gay and bisexual (LGB) people, particularly their disclosure of sexual orientation. LGB people are more at risk of certain healthcare conditions than heterosexual people; disclosing sexual orientation allows healthcare professionals to consider the most appropriate approach to treat the concerns of LGB people. Previous literature suggests that lesbians use techniques to assess the safety of a healthcare environment before choosing to disclose their sexual orientation (Hitchcock & Wilson, 1992). No previous study to the author’s knowledge has explored British LGB people’s experiences of healthcare consultations. Six students between the ages of 18 and 25 from the University of Leeds were interviewed using semi-structured interviews. These were analysed using interpretative phenomenological analysis (IPA). Individual analyses are presented followed by a group analysis detailing master themes occurring across participants. These are: somewhere safe to be free, discomfort defining sexual orientation, searching for acceptance and anticipation and fear of punishment. A process of participants’ approach to healthcare consultations and disclosure of sexual orientation is presented. A combination of participants’ search for acceptance of self and anticipation and fear of punishment seemed to shape their expectations of professionals and how they approached consultations. The interactions between professionals and participants then appeared to influence the participants’ perception of the consultations and their approach future consultations. Clinical implications of this study include: increased training for healthcare professionals around lesbian, gay and bisexual issues, so that they are better able to pick up cues from LGB patients, making it easier for them to disclose sexual orientation if they so choose. By providing the conditions for LGB people to disclose, healthcare professionals are helping to ensure that their LGB patients receive the most appropriate healthcare. 4 TABLE OF CONTENTS ABSTRACT ................................................................................................................................3 TABLE OF CONTENTS................................................................................................................4 LIST OF TABLES.........................................................................................................................7 LIST OF FIGURES.......................................................................................................................7 TERMS, ABBREVIATIONS AND CONVENTIONS.........................................................................8 Background..............................................................................................................................9 CHAPTER 1: INTRODUCTION ................................................................................................ 10 Section 1: Lesbian, Gay and Bisexual People in Britain: The Context ............................ 10 Epidemiology................................................................................................................ 10 How the British view LGB people: Past and present.................................................... 11 Section 2: Healthcare Consultations ............................................................................... 13 Doctor-Patient Interactions.......................................................................................... 13 Section 3: Identity Development and Emerging Adulthood........................................... 15 How do people realise they are lesbian, gay or bisexual? ........................................... 15 Section 4: Societal issues specific to young LGB people................................................. 19 How do LGB people tell other people about their sexual orientation?....................... 20 Section 5: LGB Healthcare: Access and Consultations.................................................... 23 Healthcare specific to LGB populations ....................................................................... 24 Accessing healthcare: LGB perspectives ...................................................................... 26 Section 6: Disclosing sexual orientation in healthcare consultations............................ 30 Research questions ...................................................................................................... 31 CHAPTER 2: METHOD ........................................................................................................... 32 Section 1: Theoretical Methodology ............................................................................... 32 Qualitative or Quantitative Methodology.................................................................... 32 Ontology and Epistemology ......................................................................................... 33 Interpretative Phenomenological Analysis (IPA).......................................................... 33 Section 2: Ethical Considerations .................................................................................... 38 Section 3: Methodology Used in This Study ................................................................... 38 Design........................................................................................................................... 38 Recruitment.................................................................................................................. 39 5 Materials ...................................................................................................................... 39 Participants................................................................................................................... 40 Participants: Summary ................................................................................................. 41 Transcription ................................................................................................................ 41 Analysis......................................................................................................................... 42 Quality checks .............................................................................................................. 44 Reflexivity..................................................................................................................... 46 CHAPTER 3: ANALYSIS .......................................................................................................... 48 Section 1: Participants ..................................................................................................... 48 Section 2: Analysis for Individual Participants................................................................ 49 Adam............................................................................................................................ 49 Ben ............................................................................................................................... 55 Camilla.......................................................................................................................... 59 Danielle ........................................................................................................................ 66 Erica.............................................................................................................................. 69 Freya............................................................................................................................. 73 Section 3: Group Analysis ................................................................................................ 76 Section 4: Reflexivity........................................................................................................ 83 CHAPTER 4: DISCUSSION...................................................................................................... 84 Aims of the study.............................................................................................................