Matthew E Coenen. Journal of Homosexuality. Volume 36, Issue 2. 1998.
The development of a sexual identity is one of many physical and mental changes that take place during adolescence. The discovery that one’s sexual identity is not one deemed “normal” by societal standards is an event that causes stress, not only for the adolescent, but for the familial system. For these adolescents, the sexual-identification process is often filled with pain and frustration; struggling with the concept of homosexuality often leads to feelings of ambiguity, confusion, and uncertainty (Troiden, 1979). Unlike their heterosexual peers, many homosexual adolescents may feel the need to keep their sexual identity a secret due to fear of discrimination and harassment. The typical middle-school or high-school is a heterosexual-only world in which terms such as “faggot,” “queer” and “dyke” are frequently used in a negative manner. Being called a “faggot” is seen as a joke or minor put-down when used on a heterosexual person; when used on a homosexual adolescent, whether homosexuality has been disclosed or not, the same term may have devastating effects.
Regardless of potential discrimination and anti-homosexual prejudices, other adolescents choose to disclose their homosexual identity to other persons. This realization, acceptance, and sharing process has been deemed ‘coming out’ and involves redefining one’s sexuality from the societally accepted heterosexual to the self-realized homosexual (Coleman, 1981/1982; McDonald, 1982). Disclosure appears to be an external measure of one’s commitment to homosexuality as an identity (Troiden, 1989); it requires a response from outside persons and these responses affect the self-esteem and self-worth of the discloser (Schultz, 1978). Reactions to disclosure are very critical; negative responses can confirm negative impressions of homosexuality and decrease self-concept while positive responses help to counteract negative perceptions and increase self-esteem (Coleman, 1981/1982).
The role of the parent (or parents) is significant to the coming out process (Savin-Williams, 1989). Acceptance of one’s sexual identity by family members is important, but many children hold back due to internal fears of rejection (Cramer & Roach, 1988), external fears of being thrown out, fears of being forced into therapy, fears of being abused, and/or potential disappointment (Ben-Ari, 1995; Gerstel, Feraios, & Herdt, 1989). In a recent survey of gay men and lesbians, 66% reported having one or more of these above fears (Ben-Ari, 1995). When disclosure does occur, family relations are immediately strained and a period of turmoil transpires (Cramer & Roach, 1988). In a study done by Remafedi (1987), half of the subjects had either lost friends and/or received negative and ambivalent reactions from parents as a result of disclosure. Of familial responses, 21% of mothers and 10% of fathers responded positively; twice as many mothers and five times as many fathers have responses vacillating between acceptance and disapproval. When parents are told (or discover) a child is homosexual, it is usually experienced negatively and is followed by long-term distress (Bozett & Sussman, 1990). Most parents report going through stages of shock, denial, guilt, and anger before accepting their homosexual child (Robinson et al., 1989); other parents never reach any level of acceptance. According to Wirth (1978, as cited in Ben-Ari, 1995), few parents ever fully accept (recognition with an affective component) their child’s homosexuality, but many learn to acknowledge (mere recognition) it. Ben-Ari’s (1995) findings show a similar trend.
Sustaining the parent-child relationship after disclosure is difficult (Ben-Ari, 1995); disclosure of homosexuality is often dismissed as a phase, an adjustment reaction, or attributed to experimentation and uncertainty (Sullivan & Schneider, 1987). Parents play no role in their child’s identity, but feel responsible because of beliefs that they influence every aspect of their child’s life. Many family members assume, before disclosure, that their child is heterosexual; having to learn otherwise is difficult for many (Robinson, Walters, & Skeen, 1989; Savin-Williams, 1989). Upon disclosing, the assumed familial role for the child is negated and family members are quick to redefine the relationship with the homosexual member based on misconceptions of homosexuality (Strommen, 1989).
It is likely that both the homosexual child and family members were reared on myths and stereotypes; because of this, all members have misinformation regarding homosexuality (Hammersmith, 1987). Homosexuality becomes confused with the consequences of stigma and is given an exaggerated importance rather than being viewed as one part of the homosexual person’s life within the broader context of social interactions. Parents need help in dealing with potential conflicts, self-esteem issues, sex- role conflicts, and negative feelings towards homosexuality (Holtzen & Agresti, 1990). Identifying as a homosexual person may seem sudden to the parents, but usually reflects much deliberation on the part of the child (Hammersmith, 1987).
The following article has two main purposes. One is to provide a foundation upon which to build and strengthen the family system; many family systems will not seek counseling, but, for those that do, the following model, based on the concepts of problem-solving communication- training (PSCT), is ideal in that it helps the family system enhance communication skills, develop reliable problem-solving skills, and both restructure and replace faulty cognitions (Robin & Foster, 1984, 1989). Families dealing with the issue of homosexuality progress through similar stages/changes and the counseling model addresses each of them (DeVine, 1984). In subliminal awareness, the homosexual member experiences feelings of guilt, isolation, and anger. The impact stage involves the actual disclosure(s); parents experience fear and guilt, and active denial is typical. Adjustment entails the use of family coping mechanisms prior to counseling; in many cases the child is urged to keep their sexual identification a secret. It is during these last two stages of impact and adjustment that therapy is often sought. Resolution and integration, two final stages, will be incorporated into the counseling model. Secondly, this article attempts to sensitize therapists to issues facing homosexual-identified adolescents and their families; relevant information pertaining to therapeutic goals and a discussion of professional attitudes are presented. The terms homosexual and homosexuality, used throughout, are meant to be inclusive of gay males, lesbians, and bisexuals.
Professional Attitudes
Professionals can only help families if their own attitudes are positive and they are knowledgeable of the current literature concerning homosexuality (Brown, 1975; Coleman & Remafedi, 1989); a lack of knowledge may limit understanding (Robinson, Walters, & Skeen, 1989). An understanding of current attitudes towards homosexuality, stigmatization effects, coming out theories and/or stages, and what it means to be homosexually identified is necessary. The literature is filled with theories on the etiological aspects of homosexuality, but no causal evidence exists (Slater, 1988); rather than having a single cause, many factors are thought to contribute to homosexuality. While the antecedents to homosexuality may never be defined, we are knowledgeable of the developmental process involved in achieving a homosexual identity. Many models of identity- formation exist (i.e., Cass, 1979; Chapman & Brannock, 1987; Coleman, 1981/1982; Cox & Gallois, 1996; McDonald, 1982; Minton & McDonald, 1984; Rust, 1992, 1993; Troiden, 1979, 1988, 1989). A majority of these models present identity development in a linear, stage-like fashion; while these stage theories have been criticized due to their limited inclusiveness and perceived “narrowness” (see Cox & Gallois, 1996; Eliason, 1996) and other, non-stage theories have been developed (such as Cox and Gallois’ [1996] process-oriented social-identity framework and Rust’s [1992, 1993] social-constructionist model), many commonalties exist regardless of which model is examined. Concepts such as confusion, awareness, acceptance, commitment, and disclosure are presented, with varying terminologies, in many of these models. A familiarity of these theoretical models is important for the therapist working with homosexual clients and their families.
Any homophobia, defined as the “irrational fear of being gay, lesbian, or bisexual or of being in contact with someone who is same-sex oriented” (Dempsey, 1994, p. 160) and the “recognized or unrecognized fear or hatred of homosexuality or homosexuals” (Slater, 1988, p. 227), may hinder the positive development of the homosexual member and negatively affect the counseling process (Maylon, 1981). If any bias exists, measures need to be taken to ensure this bias does not taint the treatment process; both adolescents and their families deserve comprehensive, sensitive, and appropriate treatment (Dempsey, 1994). Family members, especially the homosexual-identified child, need to be certain that professionals are nonjudgmental, accepting, and can maintain confidentiality. When children disclose their homosexual identification, the positivity of their disclosing statements affects family adjustment (Ben-Ari, 1995). This positivity needs to be carried over into the therapeutic setting and, ideally, should be observed not only by family members, but by the therapist as well. Children who used positive statements such as “I am gay and very happy” as opposed to neutral or negative statements such as “I am gay” or “I have a problem …” reported having an easier time adjusting, as did their parents (Ben-Ari, 1995, p. 106).
Therapeutic Goals
Upon entering therapy, both the parents and the child are apt to hold the disclosed homosexuality as the reason for all family dysfunction (Borhek, 1988). Homosexuality is perceived as a major crisis because no rules exist in the family system to handle the disclosure, no roles relevant to homosexuality are present, no constructive language to describe the issue is utilized, and strong cultural biases against homosexuality are in place; family themes and structure become critical forces against adaptation (DeVine, 1984). According to DeVine, three issues provide a source of family conflict: cohesion, regulative structures, and family themes. The first two, cohesion and regulative structures, operate along a continuum. Cohesion, at the high end, represents a family so tightly bonded that little or no autonomy exists; at the lower end, very little affectional bonding or solidarity exists. At the upper end of the regulative structure continuum, rules and role expectations are rigid whereas the lower end represents chaos and instability. How the family is projected to others, how family members define themselves as a unit, and the processes for handling problems and conflicts compose the family themes issue. A therapist working with any family system needs to be knowledgeable of how these three themes are presented and how they function in order to plan and predict therapeutic outcomes.
While some, if not most, of the familial problems may be related to homosexuality, the disclosed sexual identity is not the exclusive cause of these problems (Slater, 1988); sexual orientation issues need to be distinguished from the more general problems of the parent-child relationship (Borhek, 1988). The major focus of therapy should be to help the family members, individually and as a unit, redefine values and change stereotypical attitudes and incorrect beliefs regarding homosexuality (Bozett & Sussman, 1990; Holtzen & Agresti, 1990; Maylon, 1981). Family members need to convince themselves, based on personal experience rather than external influence, to adapt different views (Robin & Foster, 1984). It is the therapist’s job to help family members accept homosexuality as normal to some persons’ lives, unlearn myths and stereotypes concerning homosexuality, and overcome and appropriately deal with any negative consequences of stigma (Hammersmith, 1987). For the homosexual member, the ultimate goal should be in allowing him/her to maintain an individual sense of self while, at the same time, being able to preserve close family ties (Borhek, 1988).
The Counseling Process
Because homosexuality is not pathological, the skill-building and conflict-resolution segments of PSCT make it an ideal framework for use in counseling this population. Skill building contains procedures used to alter inappropriate cognitions, myths, and stereotypes about homosexuality; problem-solving teaches alternative methods of dealing with stigma; communication-training enables family members to increase the amount and quality of interactions. As with any counseling process, structure is significant in order to move towards a final goal; on the other hand, a certain amount of flexibility is required in order to deal with individual and familial differences.
Engagement
It is important to establish a rapport with all family members and affirm that all members wish to participate in the counseling process and understand it. Engagement begins with an assessment of both the family as a unit and of individual members; a careful assessment is necessary, as dynamics of the family system must be properly evaluated and information regarding family goals, problem-solving skills, belief systems, family structure, and interaction patterns should be collected (DeVine, 1984; Robin & Foster, 1984).
It may be beneficial to meet with the parents and the homosexual member separately; this allows the therapist to be on both sides at once and may increase cooperation among members (Nicholson, 1986). Meeting alone with the homosexual member also helps the therapist to make sense of potential feelings of isolation and inferiority held by the child (Robinson & Dalton, 1986). The child should be made aware that parents are not all-knowing and have their own fears, personalities, and problems; recognition of limitations affecting the child-adult relationship can then be encouraged (Borhek, 1988).
In meeting with the parents, many questions need to be considered (Myers, 1982). Questions relating to both the past (e.g., how much do they know? how did they find out? who in the family system knows? what were the reactions? have feelings changed?) and to the present (e.g., how understanding are they? how long have they known? what has the state of relations been like since disclosure? how concerned are family members?) need to be asked and guidance needs to be provided. For example, if the parent asks “what can we do?”, basic parental responsibilities should be reaffirmed. Parents may also need assistance in defining the problem as their ideas regarding family dysfunction may be considerably different from the ideas held by their child. Parents should be allowed to vent feelings and, in response, the therapist should remain empathetic and directly respond to any questions asked; normalizing the situation (e.g., “what you’re feeling is a normal reaction that many parents have when they find out a child is homosexual”) may help. At this point in the process, knowledge of homosexuality is essential; any basic questions should be answered (broadly, if necessary) and parental roles should be validated as much as possible. Both the parents and the child should be given a rationale for treatment and reminded that the family system is to be fixed, not certain individuals (Robin & Foster, 1989).
Before skill building can begin, the family should be encouraged to mourn their perceived loss (Martin & Hetrick, 1988). While the child’s homosexuality is not a negative circumstance, this process allows other family members to mourn the loss of an assumed heterosexual family member, begin creating a new role for the actual homosexual member (Bozett & Sussman, 1990), and have a sense of closure (Budman & Gur- man, 1988). In order to facilitate this process, the therapist should help specify the loss by exploring the meaning and identifying the loss in relationship to other members of the family; information should be provided about responses to this type of loss (e.g., it will take time, but it will not last forever), and regrieving is to be encouraged (e.g., have members recount the process of disclosure in greater detail).
Skill Building
Skill-building techniques must be taught in order for resolution, DeVine’s (1984) fourth stage of the family reaction process, to take place. Throughout the skill-building process, family members need to work together and the therapist should emphasize that the techniques used are meant to help resolve specific disputes and alleviate communication problems (Robin & Foster, 1984). Skill building addresses three areas: problem-solving, communication-training, and cognitive restructuring. If the family has deficits in resolving disagreements or communicating, problem-solving and communication-training should be stressed. If the family appears to have the necessary skills but does not adequately or appropriately utilize them, cognitive restructuring and other functional/structural interventions should be the focus of therapy. If the family adheres to unrealistic beliefs and expectations, utilize cognitive restructuring. If functional/structural problems are present and/or there is a history of therapeutic resistance, again, concentrate on functional/structural interventions. The perceived problems dictate the type of intervention(s) to be used; if additional problems are present, other techniques prescribed by the therapist may be employed.
Problem-solving involves five steps: problem definition, generation of alternative solutions, decision making, planning implementation of the solution, and renegotiation. When defining the problem, each family member should be allowed to speak in turn and give their understanding of what they think the problem is. Each definition needs to be concise and non-accusatory, and address behaviors, feelings and situations. Definitions should not involve personal characteristics or contain distortions, deletions and additions; if this does happen, the therapist needs to interrupt the process and immediately correct any problem.
Once the definitions have been stated, solution generation can begin. In any solution-based therapy, solutions should be future based and positive; this facilitates further change and allows the focus of therapy to be solution- rather than problem-oriented (Walter & Peller, 1992). Family members should be asked to list solutions to the problems at hand and to provide input on each solution generated (Robin & Foster, 1984, 1989). Well-defined goals are positive (e.g., we will… rather than we will not …), in process form (e.g., will be listening …), in the here and now, as specific as possible, within the client’s control (e.g., the client will …
rather than someone else will…), and in the client’s language (Walter & Peller, 1992). After all solutions have been discussed, a consensus needs to be reached on which solution will be implemented; if this cannot be accomplished, a compromise is looked for (Robin & Foster, 1984, 1989). Next, the family needs to determine how the solution is to be implemented (e.g., who does what, when, where, and in what capacity). Once these details are determined, the family can try and put the proposed solution into practice; the goal of problem solving is to learn to utilize these skills outside of the therapeutic milieu. If the solution does not work as planned, renegotiation can occur in future sessions and the problem-solving process repeated.
A second technique used in the skill-building phase, often concurrently with the problem-solving process, is communication-training. Communication-training is an informal procedure in which the therapist interrupts the inappropriate behavior, labels it, provides instruction, models the appropriate (versus inappropriate) behavior, and requires the family to replay the previous scene. The therapist needs to make sure he or she does not withhold feedback until the end of the session as immediate feedback often has a greater impact. Inappropriate communication skills to be looked for include accusatory statements, lecturing, and mind-reading; these skills need to be replaced with positive habits such as active listening, eye contact, and appropriate postures and nonverbals (Robin, 1981). By directing feedback to dyads or triads, the therapist can demonstrate to each family member how a deteriorating discussion can be improved.
A third technique used during the skill-building phase is cognitive restructuring; the steps are similar to those used in communication training. The therapist needs to give a rationale relating thoughts, feelings, and behavior; identify inappropriate cognitions and/or cognitive processes; challenge them; model appropriate cognitions; propose an experiment; and help the family to plan a strategy to rehearse these alternative cognitions.
When restructuring faulty cognitions, furnishing correct information is a necessity (Gonsiorek, 1988; Robinson & Dalton, 1986). In a study by Ben-Ari (1995), both parents and homosexual children agreed that the parents’ background usually contained no information pertaining to homosexuality. This lack of information tended to have a negative effect on family dynamics following disclosure; family members had a more difficult time getting along and parents were more likely to report feeling shame, denial, and anger. While Ben-Ari suggests that children introduce homosexuality as a concept prior to disclosure, this may not always be possible or feasible. The therapist should supplement the therapeutic process with a strategy of informational education regarding homosexuality (Coleman & Remafedi, 1989; Hammersmith, 1987). Educating about homophobia and homosexuality helps family members to overcome irrational fears and cognitions (Borhek, 1988); accurate information can help parents to realize that family background appears to have nothing to do with the sexual identification process (Martin & Hetrick, 1988). Social support groups available outside the professional setting need to be mentioned (Dempsey, 1994; Hammersmith, 1987). Books such as Now That You Know: What Every Parent Should Know About Homosexuality (Fairchild & Hayward, 1989) and Free Your Mind: The Book for Gay, Lesbian, and Bisexual Youth and Their Allies (Bass & Kaufman, 1996) are invaluable resources for both the therapist and family members, and additional information can often be found in relevant professional journals.
Intense Conflict Resolution
Throughout the skill-building phase, the therapist is constantly formulating hypotheses regarding cognitive distortions and any other family functions in need of change (Robin & Foster, 1984, 1989). Once these have been identified, intense conflict resolution can begin. Techniques previously used are focused on severe anger-producing issues that are central to the function and structure of the family. In this stage, the therapist should not try to be a teacher (as in previous sessions), but an observer who gives feedback and instruction when absolutely necessary.
Disengagement
Once the family’s loss is mourned, knowledge is acquired, misconceptions are cleared up, and skills have been built and practiced, DeVine’s (1984) final stage of integration is reached. Integration is a lifelong process and involves continuous change in the family structure to accommodate the homosexual member. At this point the therapist can gradually lessen his or her involvement in the process (Robin & Foster, 1984,1989); family members should be given the freedom to assume additional responsibility for their actions and, while the therapist can continue to monitor family skills, require less intervention. When the family feels they can comfortably handle any potential conflicts without outside help, the counseling process can be terminated.
Conclusion
While other forms of family therapy such as functional family therapy, relationship enhancement, and behavioral contracting have all had positive effects in reducing parent-child conflict and demonstrated short-term effectiveness and maintenance at 6-15 months (Robin & Foster, 1989), a study by Robin (1981) comparing PSCT and other forms of family therapy found that parents appeared more satisfied with PSCT. In a more recent study comparing the effects of communication-training on parents and adolescents, it was found that the treatment group members displayed an increased satisfaction with the family system (Riesch, Tosi, Thurston, Forsyth, Kuenning, & Kestly, 1993). Treatment group families received six weeks of communication-training and learned principles of problem ownership, message sending, confrontation, active listening, and conflict resolution. Because the scope of this paper does not permit an in-depth analysis of PSCT, further empirical data and discussion can be found in Robin (1981) and Robin and Foster (1984, 1989).
It needs to be remembered that the above model is only a foundation; additional techniques may be incorporated into the process. Familial problems not addressed above may surface, and other techniques may strengthen the effectiveness of the PSCT process. Important to remember, no matter the form of therapy used on a family system in which homosexuality is a critical issue, is that family members need accurate information, need to be taught better communication skills, and need faulty cognitions and beliefs replaced. Once these have been accomplished, the entire family system can function outside of the therapeutic setting and the issue of homosexuality, while still an issue, can be dealt with in a more positive and accepting manner.