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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, coining 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 coining 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.

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.

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