health issues

Use scenario below and discuss how you would proceed if working with this client. Do not use any outside sources besides journals attached. PLEASE DO NOT CUT AND PASTE PARTS OF THE JOURNAL. DO NOT DO ANY DIRECT QUOTES FROM THE JOURNAL ONLY CITE INFORMATION ACCORDING TO THE PAGE OF THE JOURNAL THAT IT PERTAINS TO IN YOUR PARAGRAPH. EXAMPLE
Scenario
Roger is an obese 40-year old man and suffers from other health issues. Roger reports that he lives alone and has very few friends. Roger is single and would like to be married. However, he is afraid that women will reject his advances due to his weight. To further complicate the issue he reports struggling with homosexual thoughts. Roger sought your help because he recently contemplated suicide.

Personal Biases and Limitations
Every counselor needs to consider personal biases and limitations carefully. If the topic is a hot-button or you lack sufficient knowledge to be effective with the client then you would need to refer. Identify possible problems in working with the client. Be clear in explaining why these issues could detract from counseling.

Goals
What goals would you like to achieve with the client? Why do you believe that these goals are important? What would you do if the client refused to accept a goal that you believe would be helpful? If you were allowed only one goal, what would that goal be? Why do you believe this would be the most beneficial goal?

 

Journal of Ethnographic & Qualitative Research
2012, Vol. 6, 62–75 ISSN: 1935-3308
intrinsically negotiated by the individuals engaged
in the composing process. The author
identified three proponents of composing processes:
author (the writer), audience (perceived
or genuine), and product (the text). In college
composition classrooms, audience includes
both the author’s peers and the classroom facilitator;
writing is often a result of the interaction
between both. Composition classrooms
entrench writers in constant negotiation among
expectations.
Flower’s (1990; 1994) investigations asked
what happens at points of conflict and points of
decision in composing processes. When the inner
voices of teachers, collaborators, and peers
speak together, how do writers negotiate these
multiple, often conflicting guides to meaning
making? How do these complex, internal representations
of meaning shape text? How does
the negotiation of inner voices shape the hidden
Meaning, knowledge, and identity in writing
have been part of a long-standing conversation
in composition studies. In 1990, Flower
showed that academic writing, in particular,
is rich with negotiation because of the context
in which it occurs: “Academic papers are typically
written in the context of a rich rhetorical
situation that includes not only the conventions
of academic discourse, but the expectations of
the instructor, the context of the course, and
the terms of the assignment†(p. 35). In 1994,
Flower asserted that writing is a social act in
which aspects of meaning and knowing are
Transforming Experience:
Negotiations of Sexual Identity in the
Composing Processes of Gay Men
William F. Berry
Cape Cod Community College
Negotiating meaning, knowledge, and identity is fundamental to composing
processes. These negotiations occur both individually and socially for
writers. Sexual identity is an intrinsic part of these negotiations, but is
often overlooked by researchers. This study explored the phenomenon of
negotiating sexual identity in the composing processes of self-identified
gay men. Using purposeful intensity sampling, I selected 7 gay men for
semi-structured interviews. These interviews were analyzed using narrative
analysis (Reissman, 2003) and the science of phenomenological
inquiry as outlined by both Giorgi (1985) and Moustakas (1994). The
data presented 7 emergent themes: (a) discovery, (b) expression, (c) courage,
(d) being out, (e) reflection, (f) negotiating public and personal identity,
and (g) integration. The essential experience of the phenomenon
was transformation, wherein the qualities of engaging sexual identity in
composing processes allowed the participants to bring deeper structures of
meaning into written form.
William F. Berry, Ph.D, is Associate Professor of Language
and Literature at Cape Cod Community College in
West Barnstable, Massachusetts.
Correspondence concerning this article should be addressed
to [email protected].
63
logic of the text? In answer to these questions,
Newkirk (1997) suggested that students are
not expressing a self, they are creating a self.
Newkirk argued that the objective characteristics
of language shaped the way in which the
social characteristics formulated the creation of
a linguistic identity, or self. Hence, negotiating
meaning, knowledge, and identity is social,
and writing is socially constructed. However,
Emig (1971) presented another answer to these
questions: “Persons, rather than mechanisms,
compose†(p. 5). Emig focused on two modes
of writing: reflexive writing (student’s feelings
about their experience) and task-oriented writing
(writing for a particular purpose). The author
emphasized the individual’s place in composing
processes. Emig accepted that language
carried meaning both socially and individually,
but argued that meaning was negotiated personally.
Hence, negotiating meaning, knowledge,
and identity is personal, and writing is
constructed individually.
While Emig emphasized the individual’s experience
in composing processes, Newkirk emphasized
the social aspects of composing processes.
Both supported Flower (1990; 1994) in
agreeing that writers are entrenched in conflict
and expectation, and that personal and social
negotiations are embedded in composing processes.
In applying this proposition, one could
argue that negotiating sexual identity in composing
processes is natural, and that there are
entrenched conflicts and expectations. Hence,
negotiating sexual identity for gay writers is
risky because the related negotiations are difficult
and complex.
When examining the discourse of gay writers,
patterns of heteronormativity emerge in
both the language and the discourse community.
Bergman (1991) discussed the strategies
that gay men use to fashion their sense of sexual
identity, and argued that gay men build their
sexual identity around constructs of heteronormativity:
“For example, since heterosexuality
approves of sex that is ‘natural,’ gay writers
have showed that homosexuality is ‘natural,’
and, thus, worthy of approval†(p. 26). The
author contended that constructing gay sexual
identity as something natural negates gay
sexual identity: “[This strategy] authenticates
both the dominant and subordinate [and is] unable
to fully acknowledge the extent to which
the former negates the latter†(p. 26). The author
explained that creating gay sexual identity
in response to heterosexuality was a way of
rendering heterosexuality as normative: “Gay
men have fashioned their sense of themselves
out of and in response to the heterosexual discourse
about them, gay men, even as conceived
by gay men, cannot be viewed outside of the
constructs of heterosexuality†(p. 26). Thus,
the language of sexuality becomes both a way
of othering those who do not fit into predominant
heteronormative categories and a means
of validating heterosexuality; the language of
sexuality becomes a way of codifying people as
opposed to a discursive tool. For example, Malinowitz
(1995) reasoned that it is not unusual
to see the issue of sexual identity in one of
two lights, as an issue of rights and/or personal
identity. The author warned, however, that
consigning gay and lesbian existence to a matter
of mere personal identity can negate the issue
of culture and community; likewise, consigning
gay and lesbian existence to a matter of
mere culture and/or community can negate the
issue of personal identity and choice:
The presence of lesbian and gay discourses
in the classroom, then, contributes
significantly to our understanding
of the ways that seemingly remote, autonomous
identities are in fact deeply
implicated in one another’s existence—
and of the ways that in writing we produce
ourselves through our production
of the other. Such notions suggest, too,
that identity is not immutable and static,
but rather may be reconstructed, repositioned,
or redefined. The absence
of a particular discourse may itself be a
message. (p. 29)
One of the ways that heterosexuality receives
affirmation is through implicit, unspoken recognition
of itself as a normative category of identification,
and most of the colloquial language
used to discuss sexuality is hegemonic and affirms
heterosexuality over homosexuality (Armstrong,
1997). Unless sexuality is otherwise
labeled, heterosexuality is always assumed.
Writers are often unaware of the social and personal
assumptions concerning language, even
when that language concerns them.
According to Armstrong (1997), in discourse,
all participants are assumed to be
Berry
64
heterosexual until information contradicts.
When other sexual identities are present in discourse,
they are often negotiated as a binary opposition:
heterosexual versus homosexual. This
kind of negotiation can create an adversarial
discourse in which the phenomena of omission
and othering can occur. However, Malinowitz
(1995) argued that systems of classifying sexual
identities had begun to change as a result of
post-modern theory:
Theorists of sexuality have challenged
the systems of classification by which
identities become inscribed, predominantly
the dualistic thinking that has
produced the homo-hetero opposition.
In popular imagination, homosexuals
are made, while heterosexuals just naturally
exist in nature. Much of the writing
that has come out of lesbian and
gay studies—influenced by postmodern
theory—challenges this dichotomy
by demonstrating how all identities are
constructed. (p. 43)
The author explained that in the complex negotiation
of sexual identity, constructions of
choice, rights, personal identity, and culture
happen from varied vantage points in both social
and individual contexts; thus, indexed in
writing are the patterns, network, and sexual
identities they carry and/or construct.
The foregoing literature review reveals some
of the myriad, complex issues embedded in the
phenomenon of negotiating sexual identity in
composing processes for gay men and presents
some of the perils of revealing and negotiating
discourses about gay sexual identity. Ilyasova
(2007) maintained that because of these perils
and complexities, the field of composition studies
has disregarded issues of sexual identity:
Within the composition field sexual
identity issues have often been overlooked,
in spite of the increasing attention
the composition field has paid to
other identity issues such as race, gender
and socio-economic class as factors
that shape writing practices. In contrast,
queer sexual identity issues have
tended to be ignored and heterosexual
identities taken, uncritically, for granted.
(p. 3)
The present study responded to Ilyasova’s assertion
and explored how the phenomenon of
negotiating sexual identity in composing processes
is a core part of composing processes.
Engaging transformation in the texts of writers
engages negotiations of knowledge and meaning
within composing processes. By recounting
how the participants negotiated their sexual
identity in composing processes, the present
study further explored how sexual identity
shape and transform both the writing and the
writer.
Method
I selected participants for this study using
“purposeful intensity sampling†(Patton, 2001,
p. 234). It was important that each participant
self-identified as a gay male and had experience
writing in academic settings. However, it was
not necessary that they were engaged in academic
writing or part of a composition classroom.
The saturated data achieved the study’s
results, and the sample size of seven fell within
the appropriate range of 5 to 25 participants for
a transcendental phenomenological study (Creswell,
2007). The seven men who constituted
the final pool of participants manifested the
phenomenon in an intense, rich, and common
manner; a brief narrative description of these
men follows:
Chris is a white male in his mid twenties
who has taken several composition courses at
a Midwest community college. Chris is an avid
writer and intrigued with literature and art. He
is a creative writer of both fiction and non-fiction
and has enjoyed his college composition
courses, where he wrote extensively for academic
purposes.
Steve is a white male who teaches reading
and literature at a Northeast community college.
He teaches reading and literature and lived for
12 years as a cloistered monk. He didn’t come
out as a gay man until after age thirty. He facilitates
writing processes in his courses, but does
not consider himself a writer. He is an ordained
priest.
Bob is a Vietnamese-American who lives in
the Northeast region of the U.S. is in his early
thirties and is very close to his family. Bob
works as a dentist and had a strict Catholic upbringing.
Bob did not come out as a gay male
until after college. His current writing is mostly
private, but he has experienced writing in college
contexts.
Transforming Experience
65
Mark identifies as a gay Christian. He is a
white male in his late twenties. Mark attended
a Christian liberal arts college where he could
not express his gayness. Mark came out as a
gay man after he left college. Mark writes for
his church and wrote several essays while in
college.
Stu is an African-American male in his early
thirties who works as an addiction psychiatrist
in a large metropolitan city in the Northeast
region of the U.S.. Stu identifies as an African-
American gay male. Stu mostly writes for professional
purposes, but has experienced writing
in academic contexts.
Kirk is a white male in his early forties who
lives in the Northeast region of the U.S. He
identifies as a gay male and has worked as a
journalist, writing in his field for predominantly
gay oriented media, as well as having done
writing in college contexts. Kirk works for a
Northeastern community college where he does
fundraising.
Tom is a white male in his late twenties
who identifies as a gay male and sings with a
gay men’s chorus, living in Northeastern city
where he also attended college. Tom does not
consider himself a writer, but he has written essays
for college and has done research papers
for academic purposes.
I used semi-structured interviews to explore
the phenomenon with the study’s participants.
Seidman (1998), in his work Interviewing as
Qualitative Research, stated: “[Interviews lead]
to deeper understanding and appreciation of the
amazing intricacies, yet, coherence of people’s
experiences†(p. 112). Phenomenology often
relies on informal, interactive, open-ended interviews
(Moustakas, 1994). Using the central
question of the study as a starting point, I interviewed
each man separately, at different times,
and in different places. I audio-recorded these
interviews and later transcribed them. The primary
questions for the interview emphasized
the focus of the study:
a) How do you feel your sexuality impacts
your writing process?
b) If you were in a basic writing class
(English 101) and asked to write a basic,
expository essay that would somehow allow
you to reveal your sexual identity, how
would you respond?
c) What are the experiences of addressing
sexual identity in your composing
processes?
The interviews incorporated other questions, as
needed for clarification and to prompt deeper
insight and description from the participants.
There was plenty of opportunity for participants
to be spontaneous and allow the interview to
take its own form. In accordance with the
methodology of qualitative research and standards
of phenomenological reduction, which
indicate that it may be necessary to conduct a
follow-up interview and verify the transcription
and transformations with the participants (Giorgi,
1985; Moustakas, 1994), I provided each participant
with a written transcription of both his
interview and the transformation of his interview
for verification.
The need to regulate the study to composing
processes in academic or composition classrooms
was unnecessary. Thus, the specific college
curricula each participant experienced was
not core to the context of this study; each participant’s
descriptions of his experiences in
and out of these varied, academic settings was
core. However, the participants needed to have
some experience writing in composition classrooms
because this experience made it possible
for each participant to understand and describe
their composing process.
In order to review the data in the early stages
of analysis, I used the process of phenomenological
reduction. Moustakas (1994) outlined
the process: “The method of Phenomenological
Reduction takes on the character of graded prereflection,
reflection, and reduction, with a concentrated
work aimed at explicating the essential
nature of the phenomenon†(p. 91). I kept
an informal research journal about my biases
and preconceptions and noted any expectations
that may have interfered with the results.
This process was ongoing throughout the data
transcription and analysis, as well as during the
write-up of the data.
I followed eight steps in analyzing the data
that Giorgi (1985) outlined. His method of data
analysis is concerned with providing the psychological
perspective of experience: “[It is] a
direct analysis of the psychological meaning of
naïve descriptions of personal experiences†(p.
1). As the present study explored the personal,
often psychological descriptions of sexual identity
in composing processes, Giorgi’s (1985)
Berry
66
emphasis on psychological meaning was essential
for my data interpretation.
First, I collected, transcribed, and reviewed
verbal descriptions of the phenomenon. Second,
I transformed significant statements from
each interview into meaning units. As I transformed
each interview into meaning units, I engaged
in imaginative variation, the art of perceiving
the interviews from various perspectives,
which Moustakas (1994) explained: “[Imaginative
variation seeks] possible meanings through
the utilization of imagination, varying frames of
reference, employing polarities and reversals,
and approaching the phenomenon from divergent
perspectives, different positions, roles, or
functions†(p. 97). This process determined all
possible significances in the data. Third, I created
a specific description of the phenomenon
based on the transformed meaning units of the
interview. I created the specific description of
each interview from the determined meaning
units. I gathered the data and sorted it to determine
relevant from non-relevant aspects of the
phenomenon, the process of horizonalization.
Fourth, I extracted a general description of the
phenomenon for each participant. Fifth, I identified
the emergent themes. In the fourth and
fifth steps, I used narrative analysis (Reissman,
2003) and more fully engaged that data. This
process allowed me to explore the narratives on
three levels: a) the external narrative mode, the
description of what happened; b) the internal
narrative mode; the description of the feelings,
reactions, preconceptions; and c) the reflexive
narrative mode where the question of meaning
is addressed and extracted (Reissman, 2003).
The use of narrative analysis in conjunction
with phenomenological methodology allowed a
richer, more complete description of the themes
to emerge. Thus, I discovered and correlated
the emergent themes of the phenomenon with
the identified meaning units of the data, and I
developed a general description of the phenomenon
as a whole. This description contained
both the emergent themes and the essence of
the phenomenon. Hence, in the sixth step I analyzed
the emergent themes in accordance to
the identified meaning units and placed each
meaning unit into an emergent theme. I analyzed
the general description of the phenomenon
by using each participant’s specific description
and transcribed interview and provided
further analysis of the emergent themes within
the phenomenon and to show how each theme
correlated with the essence of the phenomenon.
Seventh, I described each individual emergent
theme using the transcribed interviews of the
participants. Finally, I synthesized the descriptions
of the participants into a general description
of the phenomenon as a whole and the essence
of the experience. Giorgi (1985) stated:
This last step is a difficult one because
more so than with traditional research,
where conventions are already established,
one has the freedom to express
findings in multiple ways. To a large
extent, how the findings are presented
very much depends upon the audience
with whom one is in communication.
(p. 20)
Thus, I used the language and literature of the
study of composition and rhetoric and contextualized
the emergent themes, descriptions, and
essence of the phenomenon I studied.
Results
I summarize the findings of this study and
culled from each participant’s interview the
emergent themes and essential experience of
the phenomenon. From each participant’s interview,
I identified seven emergent themes:
(a) discovery, (b) expression, (c) courage, (d)
being out, (e) reflection, (f) negotiating public
and personal identity, and (g) integration. The
themes correlate with the essential experience
of the phenomenon based on the examination
of the participants’ external narrative modes
(what was experienced) and internal narrative
modes (how it was experienced) of the phenomenon
described. Transformation was the essential
experience of the phenomenon, extracted
from the participants’ descriptions by examining
the reflexive narrative mode (wherein the
question of meaning is addressed). I present
the general descriptions of the themes here.
Discovery
The participants experienced the act of writing
as providing new avenues of discovery into
their sexual identity. Chris, a community college
student in his 20’s, stated: “I came to terms
with my sexual identity first in my reading process.â€
He defined his process of discovery:
This is part of what I call my ‘me
search.’ So I take this me search and
Transforming Experience
67
I write about things that I’m reading
about that have to do with who I am
and incorporate that into my process.
I start to write and just start to brainstorm
about what can I write about?
What do I feel like writing about?
What is my objective in this? And then
I write.
For Chris, the experience of discovery led him
to understand not only how his sexual identity
shaped the perspective from which he wrote,
but how composing processes worked for him.
Similar to Chris’s description, Mark, who
identified as a gay Christian and studied writing
at a conservative Christian college, described
how writing helped him uncover his sexual
identity:
I was going through college and realizing
that I was actually gay and not fitting
this perfect mold. And after hearing
for 4 years that God can’t love gay
people and all this stuff, that’s when I
think I realized that I couldn’t let other
people decide what my life should be
about; what I should write and how I
should write it.
For Mark, the process of discovering his sexual
identity had direct impact on his composing
process:
I really needed to just figure out what
my own voice was and who I was as a
person and who I was as a spiritual being,
and I had to stop living other people’s
lives and what my parents expected
of me or what the college expected
of me and what I had to be. And I think
that’s when I realized that I could finally
start discovering who I was as a
writer rather than trying to fit someone
else’s mold and whatever they wanted
me to do.
Mark’s description of discovery highlighted uncovering
the private, more personal aspects of
his sexual identity in order to convey the more
public, social aspects of his sexual identity.
Stu, an addiction therapist who writes
mainly for professional purposes, described the
theme of discovery as such:
College afforded me an opportunity to
take lots of classes on isms: racism,
sexism, ageism, heterosexism, and homophobia.
So in college, I think, even
though I was not out, my interests grew
out of that feeling that I couldn’t necessarily,
at the time, be out without some
sort of negative repercussions.
Discovery was a way of coming to understand
both his sexual identity and his writing interests.
The participants described acts of discovery
in composing processes as something that perpetuated
the negotiation of sexual identity, publicly
and privately. They stated that discovery
occurred in composing processes before, during,
or after writing tasks. Thus, they experienced
discovery as an essential component of
the phenomenon about negotiating sexual identity
in composing processes.
Expression
The participants engaged the expression
of their sexual identity with intrigue and passion,
if not a tempered sense of external audience.
In essence, they described it as the ability
to articulate their sexual identity in writing.
Steve, a community college professor and ordained
minister, described his ideas of expressing
his sexual identity in writing. He began
with a description of writing in general: “That’s
what composition is about, painting a picture in
writing, as well as just putting words together.â€
Steve described his writing as directly affected
by his sexual identity:
I feel that we put more emotion toward
our writing than a heterosexual male
would. I think that we know that women
and men speak differently in communication.
And I think that, as a gay
man, I probably tend to do that more;
writing might be a bit more flowery.
Steve’s sexual identity affected his writing to
the extent that his writing style itself is, from
his description, inherently gay.
In contrast, Stu, a clinical psychiatrist, talked
about how his sexual identity was not expressed
in his college writing:
Although, to some degree, it did impact
the types of subjects that were interesting
to me, such as HIV and AIDS.
And the impacts of those illnesses on
gay men were certainly an interest at
the time and remain an interest, but not
to the degree that I would do any writing
on it.
Berry
68
He further stated that in his professional field,
sexual identity is often unexpressed and even
assumed:
It’s common in medical discourse to describe
or discuss a patient by their age,
by their race. Sometimes you may use
their gender as well, so you might describe
someone as a 59 year old White
male or a 27 year old Black female, and
there’s an assumption of heterosexuality
in that term. But if you have a patient
who’s gay, usually gay men, you
identify that this gentleman is a 59 year
old homosexual Caucasian male, and
depending on the writer, they may use
the word gay or homosexual. I find homosexual
tends to be used much more
often. And I guess in my own writing
as a psychiatrist, I tend to use the word
homosexual in describing men.
Stu’s description indicated that the omission of
expressed sexual identity in writing may be the
norm and affirmed that gay sexual identity is often
represented by omission and assumed heterosexual
until stated otherwise.
Bob, a very private writer by his own admission,
supported Stu’s notion. He described
the difficulty expressing his sexual identity in
writing: “When I was in college, I don’t think
I would be comfortable enough to write something
about my sexuality.†However, Chris described
expression differently:
I mean we’re experiencing a kind of
love that is foreign to the majority of
the heterosexual society, so they don’t
really know what we’re experiencing,
which is why I feel it’s important to incorporate
that into my writing style.
Chris found expression in his composing processes
as liberating because of his ability to
share his experience with others.
Through their experiences, the participants
described expression as an act of revealing.
These acts occurred both personally and
publicly. The participants’ descriptions showed
that expression varied from discreet to explicit
in composing processes. Expression also took
the form of stylistic choice, subject matter, and
genre. The expression of sexual identity in
composing processes was sometimes a way of
overcoming homophobia. Often, as the participants
described, the more indirect negotiations
of sexual identity were the effect of homophobia;
omission was a form of the expression of
sexual identity. Whether for personal or public
expression, the negotiation of sexual identity
as it is expressed in writing, an essential
component in the phenomenon of negotiating
sexual identity in the participants composing
processes.
Courage
The participants demonstrated courage
through the ways in which they chose to express
and negotiate their sexual identity in their
writing. The risk of doing so was very real for
them. Tom, who rarely wrote about his sexual
identity in academic contexts explained:
Well, you know, I just think that being
gay in our society is just really difficult.
You know, there are a lot of people
who just want you dead and who
can’t stand that fact that you live and
that you love, or that you have sex with
whoever you do.
Steve, who worked with student writing for several
years, affirmed Tom’s interpretation:
Having taught high school for several
years, I can imagine being an 18 year
old kid who’s popular on the football
team and life’s going great all of a sudden
saying, “I think I’m gonna be gay.
I think that it would be more fun to be
hated by my classmates, be thrown out
of my church (by) my parents.â€
While Tom’s interpretation of risk may not have
seemed as extreme as Steve’s, the consequences
of revealing sexual identity were often heartfelt,
as Chris stated: “