Gay, Lesbian, and Bisexual Therapy

In most cases, gay, lesbian, and bisexual (GLB) clients seek out counseling and therapy for the same reasons that heterosexual clients seek services, including relationship and family issues as well as concerns about work and social stressors. However, several therapeutic concerns specific to GLB sexual orientation include coming out and sexual identity development; anti-GLB and heterosexist attitudes, prejudice, and discrimination; and GLB relationship and family issues. Therapists who are of any sexual orientation can be effective working with sexual minority clients as long as they are knowledgeable about GLB therapeutic concerns and are relatively free of heterosexist assumptions and biases.

Coming Out and Sexual Identity Development

The Process of Coming Out

Coming out is a term used to describe the disclosure of one’s sexual orientation to others (e.g., family, friends, coworkers), either by identifying as GLB or by indicating a same-sex relationship or orientation. Someone who has not disclosed his or her GLB orientation either with significant others or at work is often referred to as being “in the closet.” Coming out is not a one-time occurrence, rather it is a process that GLB individuals have to grapple with each time they meet someone new or enter an unfamiliar environment. When thinking about coming out, GLB individuals often consider issues of safety and acceptance; for some, coming out could mean risking their employment or family relationships. Because it is commonly assumed that people are heterosexual, GLB people consider coming out important for conveying a sense of who they are, and this goes beyond sexual attraction and desire. Individuals range in their comfort with coming out. For some, disclosing sexual orientation is a natural process; however, for others, particularly when they are first gaining awareness of their same-sex attractions, it can be a challenge and may become a central focus of therapy. For example, some university counseling centers provide coming out groups, and many therapists will help clients practice coming out to others or even facilitate coming out to family members as part of the therapeutic process.

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Research suggests that it can take as many as 9 years for individuals to come out to themselves and their significant others, and for some who live and work in extremely heterosexist environments, coming out as GLB is not a safe option. Typically, GLB clients come out to friends first, followed by supportive siblings, mothers, and finally, fathers. Although reactions to coming out differ in each situation, self-disclosure often sets off a response similar to other ways a family has responded to crisis or change. Individuals close to a GLB person will have their own coming out process as they integrate new information and wrestle with their own self-disclosure issues.

Sexual identity Development

The process by which individuals become aware of their same-sex attraction and subsequently identify as GLB is referred to as sexual identity development. Many different developmental sexual identity models have been proposed, and while they can serve as useful guidelines for understanding a client’s experience, they do not capture the complex and distinct ways individuals come to understand and express their GLB sexual identity. Vivian Cass and Richard Troiden first introduced stage or phase models of sexual identity development in 1979. Numerous models followed, and while each had its own perspective, they shared several common themes. The first phase is characterized by feelings of being socially different from heterosexual peers, which are often accompanied by strong feelings of isolation and fear. Clients at this phase may not be aware of their same-sex attractions, and often will present in therapy with depression, loneliness, and illnesses. The focus of therapy is to treat symptoms rather than emphasize sexual identity concerns.

When same-sex attraction begins to have some personal relevance, a person may be in phase 2, characterized by private labeling of feelings as possibly “not heterosexual.” Such awareness can lead to extreme confusion, and some will seek therapy to work through their feelings of grief and loss of heterosexual privilege. Clients at this point are struggling with stereotypes and negative internalized messages about homosexuality as they attempt to integrate an new understanding of themselves. It is vital for therapists to not rush the sexual identity process and to match the clients’ pace, particularly with how they choose to describe themselves.

As clients enter the third phase, they find an identity label that more accurately describes their affectional and sexual attractions than the term heterosexual does. They have moved into understanding themselves as probably GLB rather than possibly not heterosexual; therefore, appropriate referrals to positive role models and community support are of particular importance. They may begin to see themselves as belonging to a GLB community, even if peripherally, and socializing with other GLB individuals is more common. Many clients find themselves experiencing a new adolescence in which they feel as if they are starting over with dating and having strong emotional attachments perhaps for the first time. It is important for therapists to provide clients with continuity of identity exploration and facilitate healthy self-disclosure.

When contacts with GLB community members are positive, clients may move into phase 4. At this point they accept, rather than simply tolerate, their sexual identity and begin an active social life. Clients may begin to label themselves as GLB, and the therapist may begin to use the language the clients use to describe themselves. Often, individuals in therapy are beginning relationships during this phase and may seek support for navigating as a new couple. Learning to self-disclose selectively and with appropriate language is also central in this phase. Sometimes clients begin to experience a great deal of distrust and anger over their position as GLB individuals in a heterosexist society. They may sever ties with heterosexual family and friends, and engage in dichotomous “us vs. them” thinking. However, as GLB individuals are met with affirming heterosexual allies and the diversity of the GLB community, they may begin to revise their philosophies by learning to trust and depend on others based on qualities other than sexual orientation. Additionally, they may deepen their understanding of their sexual identity as merely one aspect of their lives and not the central focus. Final stages of sexual identity development are characterized by a synthesizing of GLB identity with other aspects of self, in which sexual orientation is not the only defining quality of personality.

Anti-GLB and Heterosexist Attitudes, Prejudice, and Discrimination

Although GLB individuals have advanced a great deal in terms of equal rights in the past decade, heterosexist attitudes and actions continue to create challenges for GLB individuals. For example, in some states, GLB individuals can be fired simply for disclosing their sexual orientation. In most states, there is still no protection for sexual orientation for equal housing or public services. Similarly, except in Massachusetts, GLB individuals in the United States cannot marry their same-sex partners, which limits their access to over 1,300 federal benefits, including hospitalization rights, tax benefits, and family rights. In addition, through adoption prohibitions and fertility treatments limited to married couples, there is systematic discrimination of GLB individuals who wish to create families. GLB people are more at risk for violent hate crimes, and Gregory Herek’s research has shown that on average it takes 5 years to recover from a targeted attack due to one’s group membership rather than the 2 years that typically is required for a person to recover from a random act of violence. As GLB individuals encounter discriminatory practices or crimes targeted against them, they may present in therapy with issues of anxiety, depression, hopelessness, and even posttraumatic stress disorder. It is important that therapists be aware of the legal issues that GLB clients face and have appropriate referrals for legal advice and planning.

Relationship and Family Issues

Social Support

GLB individuals and couples receive less social support than do heterosexuals from their families of origin; however, they tend to report feeling satisfied with their overall level of social support. While it is true that many GLB individuals experience conflict and disruptions in their families upon coming out, for the most part GLB individuals remain in connection with their families of origin. In order to counterbalance the lack of support from families of origin, GLB people often create families of choice, a close-knit group of friends who serve in every function as family. Such constellations of support are important for therapists to keep in mind as they explore family dynamics and social support. Even if GLB clients do not report that they have close families, it cannot be assumed that there are not close networks just as vital to the client as blood relatives. Therapists should be cautioned against focusing on fragmented family-of-origin relationships at the expense of other more central systems of social support. Nevertheless, it is important to not discount that families of origin may not be providing support to GLB individuals.

Relationship and Parenting issues

Besides structural and legal obstacles to creating GLB families, many couples struggle with acceptance of their families. While GLB relationships are reported to be just as relationally and sexually satisfying as heterosexual relationships, there are few supports for same-sex relationships. Same-sex couples are often not provided with spiritual or religious recognition, and many have to form their own spiritual communities. Individuals in a same-sex couple can come to the relationship with differing experiences of coming out and sexual identity development, as well as internalized homophobia (the degree to which GLB individuals adopt negative attitudes and beliefs about homosexuality). Such internalized homophobia can negatively impact the couple relationship in numerous ways, including sexual satisfaction and intimacy, as well as communication and trust.

GLB parents, in particular, are vulnerable to heterosexism. Even though the 2000 Census revealed same-sex couples living in 99% of counties in the United States, and 55% of these couples reported raising children, same-sex partners are rarely allowed to both be full legal parents due to the limits of second-parent adoptions (only available in select cities and jurisdictions) and laws denying two parents of the same sex to be listed on birth certificates. When GLB families encounter difficulties such as relationship separation or death of a partner, they are often faced with no legal support for resolving custody issues or no legal rights to children whose parents they are in every way but in the eyes of the law. Therapists can help by acknowledging the negative impact of such extant laws on clients, supporting clients to seek GLB-affirmative legal support, and advocating for equal family rights for GLB individuals.


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  6. Whitman, J. S., & Boyd, C. J. (Eds.). (2003). The therapist’s notebook for lesbian, gay and bisexual clients. Binghamton, NY: Haworth Press.

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