The PARE model: a framework for working with mixed orientation couples.

Yarhouse, Mark A. ; Kays, Jill L.

Mixed orientation marriages are couples in which two people of the opposite sex are together despite one partner's experiences of same sex attraction. The one spouse, the sexual minority spouse, may or may not identity as lesbian, gay, or bisexual, while the other spouse is heterosexual (Buxton, 2001). It is difficult to estimate how many couples are in mixed orientation marriages. Harry (1990) reported that 42% of gay and bisexual men indicated that they were heterosexually married at one point. There may be as many as 2 million lesbian, gay, or bisexual individuals in the U.S. who are or who were previously married (Buxton, 2001).

Why do people enter into mixed orientation marriages? The most frequently cited reason for marrying is love for one's spouse, often coupled with a desire for companionship (Coleman, 1989; Edser & Shea, 2002; Hays & Samuels, 1989; Lee, 2002; Matteson, 1985; Wyers, 1987; Yarhouse, Palowski, & Tan, 2003). In addition to love and companionship, some sexual minorities report marrying to resolve their sexual identity conflicts (Corley & Kort, 2006; Dank, 1972; Wyers, 1987). Others may marry prematurely, before they have achieved a sexual identity synthesis (Dank, 1972; Higgins, 2002). Still others appear to marry in response to familial (or broader societal) expectations to marry (Coleman, 1989; Corley & Kort, 2006; Dank, 1972; Wyers, 1987; Yarhouse, Palows ki, & Tan, 2003). Many marry because they want a spouse and children; they want to have a family (Lee, 2002; Yarhouse, Palowski, & Tan, 2003).

In most cases, the non-sexual minority spouse does not know they married someone who is attracted to the same sex. As this becomes known through discovery or disclosure the relationship goes through significant changes. Generally speaking, we see four broad stages of relationship change: awareness, emotional response, acceptance of reality, and negotiating a future (cf., Buxton, 2004a; Hernandez & Wilson, 2007; Latham & White, 1978).

The first stage is awareness. This is the time of disclosure or discovery itself. This can range con siderably from the sexual minority spouse who comes to their partner to disclose an ongoing struggle with unwanted same-sex attraction to the non-sexual minority spouse finding implicating email exchanges or images on the sexual minority spouse's web site or in a social network.

The second stage is emotional response, which is often shock, disbelief, anger, and confusion. This coincides with disclosure or discovery, of course, and initial emotional reactivity can eventually give way to more compassion and empathy depending on the circumstances.

The third stage is acceptance of reality. This really entails accepting the fact that one's spouse experiences same-sex attraction. It may also involve coming to terms with any behavior that has been an expression of that attraction. Rather than deny or minimize the experiences of attraction or behavior, both spouses are able to accept that such attractions exist and that they both have decisions to make about their relationship.

The fourth stage of relationship change is negotiating a future. This involves deciding independently and together about the future of the relationship. Many factors are taken into consideration, including commitments spouses have made to each other and to their children, love and companionship that they enjoy together, issues related to sexuality and sexual expression, and so on.

In the remaining space we focus on those couples that are giving serious consideration to remaining together. We offer a four-stage framework, the PARE model, for providing clinical services to mixed orientation couples following disclosure. The four stages are: (1) Provide sexual identity therapy, (2) Address 'interpersonal trauma,' (3) foster Resilience through marriage counseling, and (4) Enhance sexual intimacy.

A Framework for Working with Mixed Orientation Couples

Provide Sexual Identity Therapy

Sexual Identity Therapy (SIT) is a client-centered, identity-focused approach to navigating sexual identity conflicts among sexual minorities (Throckmorton & Yarhouse, 2006; Yarhouse, 2008). It follows a theoretical model and empirical research on sexual identity development (Yarhouse, 2001) and empirical research (Yarhouse & Tan, 2004) on the experiences of Christians who identify as gay and those who dis-identify with a gay identity. In terms of core elements, sexual identity therapy focuses on (a) a three-tier distinction between same-sex attraction, a homosexual orientation, and a gay identity; (b) differences in weight given to aspects of identity; (c) attributional search for sexual identity, and (d) facilitating personal congruence.

A three-tier distinction. SIT makes a three-tier distinction between same-sex attraction, a homosexual orientation, and a gay identity (Yarhouse, 2005). At the most descriptive level, sexual minorities experience same-sex attraction. If the sexual minority spouse experiences a sufficient amount of same-sex attraction that is persistent and durable, he or she might report a homosexual orientation. A gay identity, however, is a more recently documented experience. It refers to a sociocultural label that can be used to communicate one's sexual preferences to oneself and to others. To some couples, a gay identity may be experienced as prescriptive of engaging in same-sex behavior or exploring same-sex relationships. Sexual minority spouses may find it more helpful to use descriptive language (e.g., "I experience same-sex attraction.") rather than form an identity around their attractions (e.g., "I am gay."), particularly if they want to focus on reconciliation within their relationship.

Weighted aspects of identity. The second core element in SIT is to look at what weight the sexual minority spouse gives to aspects of themselves as a person. Part of their experience is same-sex attraction, and many sexual minorities place most of the weight on this aspect of themselves. Their same-sex attractions function as 'trump' in terms of their overall identity. Others recognize same-sex attraction, but they also look at other aspects of their experience--for example, the fact that they were born either male or female (their biological sex); they have a gender identity (how masculine or feminine they feel); they have intentions in terms of their behavior; they have behaviors they actually engage in; and they have personal beliefs and values about sexuality and sexual expression.

Attributional search for sexual identity. SIT also focuses on what it means to join the sexual minority spouse on an attributional search for sexual identity. Now that they are using more descriptive language--talking about experiences of same-sex attraction--and reflection on what weight they give to different aspects of identity--they can consider the attributions that they make about their attractions. What do their same-sex attractions signal about them? How do they make meaning out of their experiences of attraction? Do their attractions signal a gay identity? Are their same-sex attractions the result of the fall? Do they attribute their attractions to other experiences growing up? In the end, the person is going to sort out how to think about themselves in light of their attractions and other considerations.

Congruence. The final emphasis in SIT is congruence. This refers to bringing identity/behavior into alignment with beliefs/values (or vice versa). In SIT this involves introducing the concept of congruence and giving them this as a goal and as a concept that they might not have considered previously. For the sexual minority spouse, congruence may also be tied to what they want in terms of their marriage, the love and emotional commitments they have made in that relationship, as well as other values associated with marriage, such as a covenantal view of their relationship (Yarhouse, Gow & Davis, 2009).

Address 'Interpersonal Trauma'

The primary work in SIT will be with the sexual minority, but both the sexual minority and his or her spouse can benefit from the psychoeducation component found in explaining the three-tier distinction, weighted aspects of identity, and attributional search for sexual identity. There is something to be gained in using descriptive language and coming to an understanding that decisions can be made about achieving congruence.

The main focus of the next stage of the framework is responding to the potential 'interpersonal trauma' of discovering that one's partner is attracted to the same sex. It has been suggested that disclosure or discovery of same-sex attraction or behavior in a marriage relationship can feel to the non-sex minority spouse like a betrayal of trust, particularly if there has been same-sex behavior (e.g., Yarhouse & Seymore, 2006). Even in cases in which there has been no same-sex behavior, but only attraction, it can feel confusing to the non-sexual minority spouse who may wonder if there has been deception or a misrepresentation of their spouse's identity and experience.

Although mixed orientation couples have not been studied per se, other couples researchers have looked at stages couples go through following major relationship offenses, such as affairs, deception, and violation of trust. This is the origin of the phrase "interpersonal trauma," a phrase used to designate relationship offenses, such as betrayals, affairs, and so on (Gordon, Baucom, Snyder, Atkins, & Christensen, 2006).

It can be helpful to work through a three-stage approach to the potential 'interpersonal trauma' associated with disclosure or discovery of same-sex attraction or behavior in a mixed orientation relationship. The three stages are: (1) impact, (2) a search for meaning, and (3) recovery (Gordon & Baucom, 2003).

Impact. The first stage, the "impact" stage, is when the involved partners realize the effect of the offense on the relationship and on themselves individually. This is when individuals often feel the initial emotional impact of the offense, such as shock, anger, and hurt. Individuals may describe that their prior assumptions and expectations were disrupted, which can leave them feeling out of control and disoriented (Gordon & Baucom, 2003).

A search for meaning. The "meaning-making" stage is when individuals often try to put the offense in context, understand it better, and possibly understand why and how it occurred. This helps an individual feel they have regained control and begin to reconstruct the framework of their relationship so that they can move on (Gordon & Baucom, 2003).

Recovery. The final stage is the "recovery" or "moving on" stage, and this is when individuals take their new understanding and move past the hurt so that it is no longer a major controlling factor in their life. Often negative feelings decrease and a desire for punishment or revenge (if present) is lessened. Additionally, this stage often includes a reevaluation of the relationship and a decision about how or if to proceed in it, now that their perception of the relationship and their partner has changed (Gordon & Baucom, 2003). As Gordon and Baucom indicate, there is not always reconciliation, but the process implies the individual is able to move beyond the hurt and regain a sense of identity.

For those couples who are deciding about the next step for themselves and for the marriage, the three-stage model found in the 'interpersonal trauma' and forgiveness literature can be particularly helpful. For those couples who decide to work toward forgiveness and reconciliation, it will be important to look at what can be done to foster resilience in mixed orientation relationships.

Foster Resilience in Marital Therapy

For those couples that decide to stay together, what are some practical steps clinicians can take to foster resilience? Although the research is not as well-developed as we might like, we do see some themes emerging from the studies that have been conducted thus far (for an extended discussion of these themes, see Kays & Yarhouse, in press). These themes are associated with communication, cohesion/commitment, and flexibility/role negotiation.

Support frequent and honest communication. Marriage counseling with a focus on fostering resilience in mixed orientation couples will want to improve the quality and amount of communication in the marriage. Communication has consistently been identified as one of the most significant protective factors found in the literature for mixed orientation couples (Brand, 2001; Buxton, 2001; Edser & Shea, 2002; Matteson, 1985). Improved communication is honest, open, and empathic (Buxton, 2001; Edser & Shea, 2002; Matteson, 1985). This kind of open and honest communication, when done frequently, appears to enhance intimacy and trust in the marriage (Edser & Shea, 2002; Matteson, 1985). Of course, clinicians will want to be aware that issues germane to mixed orientation couples will touch on many personal issues, such as sexuality and sexual behavior, grief (often for the non-sexual minority spouse) and identify confusion (often for the sexual minority spouse), as well as if and how they are going to negotiate their relationship, particularly issues related to sexual intimacy (Duffey, 2006).

Strengthen emotional bond. Another important resilient factor in mixed orientation marriages is the couple's experience of emotional closeness or cohesion (Brownfain, 1985; Buxton, 2001, 2004b; Edser & Shea, 2002; Matteson, 1985; Yarhouse Gow, & Davis, 2009). Clinicians interested in fostering resilience in mixed orientation relationships can help couples build the emotional bond that they have with their partner, and they can take steps to cultivate their commitment to their marriages. They can review reasons for marrying and identify reasons for staying together, sharing these with one another. It may also be helpful to tap into religious resources and key concepts that support their commitment (e.g., a covenantal view of marriage) and cohesion.

Demonstrate role flexibility. The final factor associated with resilience in mixed orientation marriages is the ability to be flexible and renegotiate the roles and rules that have characterized their relationship (Buxton, 2004a). One area often addressed in terms of compromise and negotiation is in their sexual relationship. Some couples foster a close, emotionally supportive but platonic relationship, while others might have a more "open" marriage in which one or both spouses see others outside of their marriage (Ross, 1971; cf., Brownfain, 1985; Dank, 1972; Latham & White, 1978). Still others commit to both emotional closeness and sexual faithfulness within the marriage (Yarhouse, Gow & Davis, 2009). In the spirit of fostering the commitment spouses have for one another, counselors can work with the couple to enhance sexual intimacy with the marriage rather than look to explore sexual identity and behavior outside of marriage. We turn now to steps that can be taken to enhance sexual intimacy in mixed orientation marriages.

Enhance Sexual Intimacy

It is important to communicate early on that the couple is developing something unique together. In other words, they are not comparing their sexual intimacy to that of others or to past experiences; rather, they are pouring into their own relationship and creating something that they can both enjoy. This is very similar to what should be communicated in general sex therapy with a heterosexual couple, but it is also important to communicate as couples in mixed orientation relationships may have worries that lead them to make comparisons that will ultimately detract from their experience. This can include a discussion of 'ghosts' in the bedroom, thoughts of former partners, or the insecurities that can come when the non-sexual minority spouse worries about that being on the mind of the sexual minority spouse.

Another area to discuss is different experiences of desire. This can be thought of as a difference in desire rather than pathologizing either the high-desire or low-desire partner. But it can be helpful to discuss levels of desire and to look at reasonable compromises that reflect a mutual understanding of both partner's interest in cultivating their sexual life together.

It is also important to explore lifestyle and routine, to gauge whether attending to their sex life is a priority and can be given the attention it needs at this time. This can be done by asking about a typical day during the work week, as well as a typical weekend. How does the day begin? What events and commitments occur throughout the day? How do they communicate with one another? How does the day end? What about other commitments to the community or the neighborhood or schools or the religious organizations?

It can also be helpful to have the couple engage in enhancement exercises. These are typically nondemand sensual touch exercises that are not geared toward orgasm or intercourse but rather focus on communication in which each partner has time to identify what they like and share that information constructively with one another.

Sofa sessions can also be assigned. These are opportunities for the couple to discuss topics that may range in level of anxiety, so the couple could begin with a low anxiety topic, such as favorite transition activities (transitioning to sexual intimacy together), and they can work their way up to more high anxiety topics, such as how they handle initiating sex and declining sex in their marriage.

Mindfulness exercises can also help couples stay focused on one another and on what each of them experiences. Sexual intimacy can sometimes lead to increased levels of anxiety and comparisons with previous partners. Rather than focus on the negative, spouses can be taught to use mindfulness exercises to calm themselves, to accept their experiences with less judgment and emotional reactivity. They can also attend to their five senses to increase awareness of themselves and their partner and to ground their experience in the here-and-now. This can be particularly helpful when coupled with nondemand sensual touch exercises to enhance experiences of intimacy and communication.

Conclusion

Mixed orientation couples are only now really being studied and understood, particularly those couples that choose to stay together. This article offered a research-informed framework for working with these couples that involves key psychoeducational components found in SIT, dealing with potential 'interpersonal trauma' from the couples' forgiveness literature, improving marital resilience, and enhancing sexual intimacy.

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Mark A. Yarhouse and Jill L. Kays

Regent University

Mark A. Yarhouse (Psy.D. in Clinical Psychology, Wheaton College, 1998) is the Hughes Chair of Christian Thought in Mental Health Practice and Professor of Psychology at Regent University, Virginia Beach, Virginia, where he directs the Institute for the Study of Sexual Identity (www.sexualidentityinstitute.org). Dr. Yarhouse's interests include clinical psychology of religion, applied integration, marriage and family therapy, and sexual identity.

Jill L. Kays (M.A. in Clinical Psychology) is a Psy.D. Candidate in the Doctoral Program in Clinical Psychology at Regent University. Her research and clinical interests include marriage and family, positive psychology, identity development, and human sexuality.