A review of Adjustment and Change among Bisexual Women: A Longitudinal Analysis, by Jane Caflisch.
While the complexity of Jane Caflisch’s impressive longitudinal mixed methods study cannot be captured within the scope of this brief review, highlighted here are some of the main concepts, methods, and findings that make this study stand out from other research. In her opening chapter, Caflisch offers an extensive review of existing sexual identity theories, from Freud–who in 1905 posited that all humans inherently have a capacity for bisexual experiences–to more recent Neo-Freudians who posited that one must resolve rather than embrace contradictions to achieve successful identity integration, such as Erik Erikson (“The problem of ego identity,” Journal of the American Psychoanalytic Association 4 (1956), p. 61-81) and Salman Akhtar (“The syndrome of identity diffusion,” American Journal of Psychiatry 141:11 (1984), p. 1381-1385).
The central theoretical contribution of Caflisch’s study is thus her proposal of an “alternative model of identity integration built around the toleration of multiplicity within one’s self and one’s relationships” (p. 39), building on post-modern theories about sexual fluidity like those put forth by Stuart Pizer, (Building Bridges: The Negotiation of Paradox in Psychoanalysis. Hillsdale, NJ: Analytic Press, 1998), Philip Bromberg (Standing in the Spaces: Essays on Clinical Process, Trauma and Dissociation. New York: Routledge, 2001) and Lisa Diamond (Sexual Fluidity: Understanding Women’s Love and Desire. Cambridge, MA: Harvard University Press, 2008).
Another major aim of Caflisch’s study is illuminating factors that may be contributing to increased psychological distress, as well as factors that support healthy psychological adjustment, among bisexual women. To do so, Caflisch closely followed the participants’ experiences on multiple levels, including intrapsychic, relational, and environmental. At the outset, she hypothesized several possible relationships between factors that may influence a bisexual woman’s overall adjustment and well-being.
As she details in Chapter 3, Caflisch publicized her study online and through a newspaper in New York. To reach dually attracted women, Caflisch used the wording “ongoing attractions to both women and men,” rather than the term “bisexual,” with which many sexual minority women may not identify (p. 48). Though Caflisch’s participants did not all identify as “bisexual,” all had been intimate with both males and females. When data collection began in 2008 at Time 1, participants comprised a sample size of 50, ranging in age from 26 to 36, with 40 of the participants continuing at the Time 2 follow-up 12 to14 months later. Data collection was completed by January 2010. More than half of the participants were women of color; 50% of participants were single, 27.5% dating, 20% in a relationship, and 2.5% were with multiple partners. The sample also included variation in education, income, and religious affiliation. Interestingly, participants who did not return for follow-up were more likely to have expressed a sense of conflict related to religion at Time 1.
Caflisch administered several previously validated measures to each participant, as well as conducting 60-90 minute recorded interviews. The measurement instruments included the Brief Symptom Inventory, the Rosenberg Self-Esteem Scale, the Positive and Negative Affect Scale, the Experiences in Close Relationships Scale, the Need for Closure Scale, and an adapted version of the Sexual Risk Behavior Assessment Schedule. Detailed training provided for five interviewers working with the researcher contributed to the rigor of this study.
After the collection of quantitative data, Caflisch analyzed it using multiple linear regression. Interviews were transcribed, with careful attention to affect and tone of voice in addition to content. Caflisch and her assistants first analyzed the extensive data from the interviews using grounded analysis, developing a codebook from the qualitative data as each interview was completed. Next, they applied a quantitative analysis to the interview data, a complex process of rating content using multiple scales. These scales focused on the following areas: community support for bisexuality, community stigma against bisexuality, internal and external pressure for singular sexual orientation, attachment/sexuality integration, capacity to tolerate paradoxical aspects of bisexuality, and the particular answers given for the “self as sexual being” item of the Object Relations Inventory. Inter-rater reliability usually differed by no more than one point, and discussion was used to reach consensus where any difference occurred between analysts in rating participant responses.
I felt especially captivated by the women’s life experiences as portrayed through their own words in Chapter 4, in which each describes her own relationships, thoughts, ideas, and feelings. As Caflisch notes, regardless of dualistic currents in psychological theory, it is not considered a healthy coping mechanism to split off parts of oneself due to the lack of support for a bisexual identity. However, bisexual identity can actually support a holistic identity and sense of self. As one participant describing her identification stated,
“Initially I found the term very alienating, partly because it seemed to imply this perfectly equal split, or seemed to imply perhaps that you didn’t care at all about a person’s sex, and you just were attracted to the inner person… neither of those things seemed to apply…. This particular box felt vague, but it probably served better than anything else, and it was important to me not to be someone who became the person I was with – so if I was with a man, I’m straight, and if I was with a woman, now I’m a lesbian. That felt disingenuous and also disrespectful of the people I had loved in the past. And so… I liked about my sexuality that it owned that past” (p. 136).
Chapter 5 continues the insightful discussion begun in Chapters 3 and 4, weaving together the quantitative and qualitative findings that further illuminate each other, and emerging with the study’s conclusions. Most importantly, “[t]his study provides preliminary support for an alternative understanding of identity integration for bisexual women built around the toleration of paradox and ambiguity, as these may exist both cross-sectionally and in the context of change over time” (pp. 173-174).
Caflisch’s further hypothesized relationships, substantiated through her findings, included the following. For one, important factors for adjustment include the beneficial role of relational and community support for a bisexual identity. Conversely, community stigma, and pressure for a singular sexual orientation, are factors that negatively affect adjustment. Additionally, their actual relationships shaped how the women interpret their bisexual life experiences. The capacity to experience both emotional and sexual intimacy with a partner regardless of gender was associated with greater well-being, as compared to being able to experience only one of these aspects of intimacy depending upon the partner’s gender. Indeed, partner support for the openness of her dual attraction was an essential factor in a bisexual woman’s sense of integration.
This research also revealed several important, specific findings among the participants. Women of color generally reported more distress and less community support than White participants. Significant differences were also identified for women whose data included at least 10 instances reflecting borderline personality organization (BPO), as differentiated from the diagnostic category of borderline personality disorder (diagnosis was not included during the course of the study). Participants (n=9) whose responses reflected BPO were more likely to experience greater difficulty around adjustment.
At close, Caflisch makes a number of recommendations for future research. These include a follow-up with participants over a longer period of time; and the importance of studies with comparison groups to determine how the issues identified in her subjects may be experienced differently by women identifying as lesbian or heterosexual. Additionally recommended is a similar study with bisexual men, which might help determine how the issues researched in this study may be experienced differently by gender.
I highly recommend reading Jane Caflisch’s study in detail. Accompanying the chapters are in-depth illustrations and charts, including the complete codebook used during her analysis of the qualitative data. While her findings cannot necessarily yet be generalized, Caflisch makes a very useful contribution to the field of LGBTQ clinical psychology. The results of Caflisch’s study are particularly important knowledge for health practitioners who wish to have a knowledgeable and more culturally competent therapeutic framework from which to support guidance for bisexual women. The findings of this study raise our consciousness about the range of “normalcy” for bisexual women, and the factors that support healthy adjustment over each woman’s lifespan. These findings can also be potentially therapeutic when read by bisexual women themselves: they would benefit from Caflisch’s highly accessible theoretical and conceptual frameworks, which can help them better understand their life experiences over time, as well as point to helpful solutions for a more integrated sense of self.
Kristin M. Brown
College of Social Work
Florida State University
Measurement instruments administered to participants at the beginning of the study and 12-14 months later during follow-up.
Recorded individual interviews with participants at the beginning of the study and 12-14 months later during follow-up.
The City University of New York. 2013. 262 pp. Primary Advisor: Margaret Rosario.
Image: Bisexual flag. Wikimedia Commons.