Sexual orientation is the romantic, sexual or emotional attraction to another person. It is important to distinguish sexual orientation from other concepts with which it is often confused. Sexual orientation is different from biological sex, which refers to the physical sexual characteristics with which people are born. Sexual orientation is also different than gender identity, which is the psychological sense of being male or female. Finally, sexual orientation needs to be distinguished from the term gender, which can be defined as the socially constructed adherence to cultural norms for feminine and masculine behavior, thoughts and feelings (Answers to your questions, n.d).

Sexual orientation cannot be viewed as a dichotomous variable since it exists along a continuum that ranges from exclusive homosexuality to exclusive heterosexuality and includes various forms of bisexuality (Answers to your questions, n.d.; Elze, 2006; McClellan, 2006). The traditional polarization of sexual orientation into two discrete categories, homosexuality and heterosexuality, leaves out bisexuality and other sexual orientations. (Division 44, 2000). An understanding of the differences between gender identity, gender expression, and sexual orientation is important. Sexual orientation refers to one’s sexual attraction to men, women, or both, whereas gender identity refers to one’s sense of oneself as male, female, or transgender, and gender expression is the behavioral expression of either the gender identity or the sexual orientation (Answers to your Questions, n.d.).

This section is divided into two subsections. The first subsection focuses on gay, lesbian and bisexual orientations, titled Heterosexuality, Homosexuality and Bisexual Gender Orientations, contains an introduction to these topics followed by the story of Karen, a woman who found out after having been married for several years, that she was attracted to another woman. We read about her journey toward self-knowledge, self- expression and self-acceptance. The second sub-section, titled Transgender and Intersex Sexuality, focuses on transgender and intersex issues and contains an introduction to these topics, followed by a story written by the mother of a transgendered child, in which we read about the transformation of Ryan into Rachel. Each story has its own Content Themes and Clinical Applications sections and each includes its own Toolbox Activity.

Heterosexuality, Homosexuality, and Bisexual Gender Orientations

Homosexuality can be defined as the orientation of people who “identify inwardly as male or female in accordance with their genitals, and whose primary erotic attraction is to their own sex” (Johnson, 2004, p.79). People with a heterosexual orientation are commonly referred to as straights, and people with a homosexual orientation are sometimes referred to as gay (both men and women) or as lesbian (women only). (Bisexual individuals can experience sexual attraction to both their own and the opposite sex, regardless of their behavior (McClellan, 2006).

The best estimate of individuals who are gay or lesbian in the U.S. was made by Alfred Kinsey in his study of sexuality in the 1940s and 1950s. Kinsey’s data suggest that 10% of the U.S. population was homosexual (Miller, 1995). More recent data suggest that anywhere between 2 and 10% of the population is gay or lesbian (Smith & Gates, 2001). It is difficult to estimate the number of people who identify as gay, lesbian, bisexual, because there is a fear of discrimination or victimization by identifying as other than heterosexual (Smith & Gates, 2001). The “Don’t ask, don’t tell,” policy in the United States military, which advocates for hiding one’s sexual orientation in order to serve in the military (Gates, 2004) mirrors the written or unwritten policies in work, family and social environments where people do not feel free to reveal their sexual orientation.

Historical Data

Same sex intimacies have been documented in all historical periods. Same-sex eroticism was considered acceptable and expected at some historical times and places and condemned in others (Tully, 2000). By the end of the Middle Ages, homoerotic activity was equated with sodomy, which was considered a sin (Tully, 2000). As homosexuality began to be understood as a biological expression in the 19th century, public attitudes looked to science to explain and eventually condemn homosexuality (Moses, 1982). Although same sex behavior has always existed, sexual orientation is a relatively new concept and the idea of homosexuality as a category is only about 100 years old (GLBT Fact Sheets, n.d; Roseneil, 2002; Tully, 2000). Homosexuality was often referred to as the practice of the “invert”, the “third sex”, and the “intermediate sex” until 1869 (Miller, 1995). These terms reflect an evolution in nineteenth-century thought from a “moral and religious attitude toward same-sex relations to a scientific one” (Miller, 1995, p. 13). Homosexuality went from being considered a sin to a medical/scientific category (Miller, 1995) viewed as deviant, pathological, and criminal (Moses, 1982). The term “homosexual” was first used in 1869 by a German campaigner for decriminalization of sexual relations between men (Miller, 1995). The creation of this term, however, did not mean acceptance.

Homosexuality as a category meant a medical condition in need of a cure. Freud contributed to this view by theorizing that homosexuality was caused by arrested development at an early developmental stage that prevented the young man or woman from reaching the developmental goal of heterosexuality (Miller, 1995). Freud did contend, however, that everyone is innately bisexual, and rejected the idea that it was possible to transform homosexuals into heterosexuals, which was an unusually tolerant position for his time. He considered that sexual orientation was both constitutional and at the same time acquired during the early developmental years. He believed sexual orientation to be well established before adolescence and that attempting to change it was neither a feasible nor a desirable goal of therapy. Freud was convinced that it was as difficult to change the sexual orientation of gays or lesbians, as it was to change the sexual orientation of heterosexuals. He was also sure of the bisexual disposition in all people, regardless of their sexual orientation (Gay, 1989; Miller, 1995). Freud’s view of arrested development, however, contributed to the belief that homosexuality is, therefore, learned and can be cured. The medical-oriented approach resulted in viewing gayness in terms of mental illness with a slant on rehabilitation (Moses, 1982). Treatments that were often forced upon patients included induced seizures, nausea-induced drugs, electroshock, covert sensitization, having gay men masturbate while viewing pictures of a nude woman, lobotomies, castration, and implantation of “normal” testes (Hunter & Hickerson, 2003). The members of the early American psychiatric establishment maintained that homosexuality could be corrected with treatment until 1973, when the American Psychiatric Association altered its position by declaring that homosexuality is not a mental disorder. The classification of homosexuality as a mental disorder was not changed until the 1987 revised edition of the DSM-III (Hunter & Hickerson, 2003).

Currently, conversion therapies or reparative therapies are practiced and encouraged (Spitzer, R.L., 2003), even though they have been rejected as unscientific by the American Psychological Association (Deleon, 1998), the American Psychiatric Association, American Psychiatric Association Commmission, 2000), the American Counseling Association (Whitman, Glosoff, Kocet, & Tarvydas, 2006,) and the National Association of Social Workers (Hunter & Hickerson, 2003). Conversion therapies are not only scientifically unproven, but serious ethical questions arise when using a form of therapy that may be harmful to clients. The American Psychiatric Association board noted that conversion therapy can cause depression, anxiety, and self-harming behavior and voted in 1998 to renounce any therapy with the goal of converting gay and lesbian individuals (Hunter & Hickerson, 2003).

Gay is a term generally used to describe men who are attracted to, or sexually involved with, someone of the same sex. It came into use within the subculture in the 1920’s, and became used by the general public in the U.S. after Pearl Harbor (Miller, 1995). Lesbian is a term used to describe women who are attracted, to or sexually involved with, someone of the same sex. In the Victorian Era, lesbianism was known as romantic friendships, in the 1950’s as, “the love that dare not speak its name”, and the term lesbian came into popular use in the early twentieth century (Faderman, 1991, p.139). Bisexual experimentation gained popularity in the 1920’s as the Victorian Era faded, a new rebellious culture emerged, people took notice of Freud’s assertion of all human beings’ bisexual nature, and World War I created a culture of separate sexes (Faderman, 1991). Sociological research in the 1930s and 1940s led to the view of gays and lesbians as social deviants, which pointed to environmental causes for the deviance (Moses, 1982).

The rise in social activism movements spawned by the civil rights movement is a recent development. The Gay Liberation Movement was born at the time of the Stonewall Rebellion of 1969 in Greenwich Village, which was an important historical marker of the gay civil rights movement (Miller, 1995). After years of police raids on gay bars and harassment by the police, the patrons of the Stonewall Inn fought back during a police raid on June, 28, 1969 that spurred a three-night riot between the police and the crowd at the Stonewall Inn. While homosexuality, bisexuality and transgender issues are “coming out of the closet” (Blumenfeld, 2000, p. 261), so is the backlash against it. Hate crimes against lesbian, gay, bisexuals and transgender are on the rise (PFLAG, n.d. p.1).

Current Views on Gender Socialization and Sexual Orientation

The relationship between sexuality, sexual orientation, and gender is a complex one involving multiple cultural, biological, social, cultural, and genetic aspects (Birke, 2002). Current scholarship regarding gender socialization generally reveals a description of a permanent interaction between biological and cultural/constructivist perspectives (Mitchell & Black, 1995). Gender socialization is understood as a complex psychological and social construction, not as a simple extension of either anatomically based reproductive capacities or brain physiology. In terms of gender socialization, this means that people are not only born as male or female, but “learn to be women and men” (Lorber, 2000, p. 204) in reciprocal interactions between anatomy, social expectations of male and female behavior, and other complex gender based socialization experiences, such as gender role expectations and gender role responsibilities (Moses, 1982). Genes, hormones and biology contribute as much as social practices to the construction of gender socialization. It is now understood that, as anything else that is human, gender identity cannot be thought of as devoid of the influence of culture.

With respect to sexual orientation there is controversy regarding the importance of determining its causes in the medical and social science literature. The controversy surrounding the origins of sexual orientation has strong political, religious, and social implications. Research on the origin of sexual orientation shows contradictory and inconclusive data. Scientists do not know what “causes” homosexuality anymore than they know what “causes” heterosexuality. The complex interaction between genes, sex hormones, pre-natal and environmental determinants has not been elucidated. The idea that early exposure to homosexual experiences or that exposure to early homoerotic abuse leads to later homosexual development is generally not supported in the scholarly literature (Butke, 2002; Johnson, 2004), though childhood sexual abuse can accelerate or retard identification of a gay sexual orientation (Arey, 2002). There is some evidence that suggests that biological or genetic markers and brain structural differences for sexual orientation may exist (Birke, 2002; Johnson, 2004). In addition to genetic and other biological factors, it is suspected that a multitude of environmental and psychosocial factors may have a profound influence on the sexual differentiation of the brain, and later, on the development of children, and adolescents (Birke, 2002). There is also some indication that the biological and environmental mechanisms underlying homosexuality may be different for males and females and for people with a bisexual orientation (Esterberg, 2002).

Regarding the need to understand the origins of homosexuality, important questions arise. If homosexuality were not a stigmatized behavior, would there be an interest in finding out the reasons for its origin? Why is there not a similar push to find out the reasons for heterosexuality? If heterosexuality was not viewed as the norm, from which homosexuality deviates, would the question: “What makes people gay?” have any meaning at all? There is a lot at stake in the answers to these questions. Some supporters of gay rights contend that finding the genetic markers of homosexuality would end the controversy and advance the gay rights cause by reducing discrimination and putting an end to the idea that homosexuality can be contagious (Birke, 2002). Other scholars contend that, on the contrary, focusing on the causes and origins of homosexuality is itself a homophobic activity that merely reinforces the prejudices. From that point of view, “What makes people gay?” is not an important or even a relevant question (Blades, 1994; Hersch, 1991).

To frame the issue of homosexuality as one that oscillates between biological determinism and social constructionism only is to attempt to simplify the complexity of the issues. Some examples of that complexity follow. First, there may be numerous forms of homosexuality and heterosexuality. Some authors contend that homosexuality is fixed and cannot be changed or consciously chosen (Answers to your questions, n.d.; Butke, 2002). Other authors argue that sexual orientation is fluid and that people can fall anywhere along a continuum (Roseneil, 2002), and that “there is not a homosexuality, but homosexualities” (Nardi, 2002, p. 46). Second, sexual behavior cannot be the only dimension considered; fantasy, sexual attraction and desire, love, self- identification and culturally sanctioned expectations and behaviors also need to be taken into consideration (Hersch, 1991). Third, there is diversity within sexual orientations and there can be different typologies of gay, lesbians or bisexuals. For example, in “Latin bisexuality” found in some Latin American societies, men may engage in overt same-sex behavior, and as long as men play the active or “insertive” role, they are not considered homosexual (Esterberg, 2002, p. 219).

For most people, sexual orientation emerges in early adolescence without any prior sexual experiences. It appears that men, on average, know that they are gay earlier than women (Arey, 2002). Many men and women generally report knowing they were gay from very early on, but some awaken to their lesbian sexual orientation later in life. It is unclear whether a post adolescent awakening is even possible, whether it is a result of the denial and repression of earlier homosexual feelings or tendencies, or whether it is a reflection of differences between men and women’s origins of homosexuality (Esterberg, 2002).

The lack of full consensus surrounding much of the issues about sexual orientation is a reflection of the lack of available knowledge, but is also a reflection of the profound social, cultural and political implications of each position.

Clinical Considerations

When counseling gay, lesbian or bisexual (GLB) clients or their families, it is important for clinicians to take into account several considerations.

Homophobia

As a sexual minority, GLBs are at high risk of stigmatization, discrimination, marginalization, and violence (Tully, 2000; Swan, 1997). Blatant discrimination has existed under authoritative pretexts, and excluded many from military service, employment, and housing. Sometimes GLBs suffer at the hands of their own parents, siblings, and other close relatives. Like members of other oppressed groups, there has been historical hostility and stigmatization of those who have not identified as heterosexual, considered to be the norm with which homosexual and bisexual orientations are compared. The persecution and oppression is often based on religious grounds, but also on scientific ones. As with other oppressive experiences, homophobia can become internalized, exerting its influence from within instilling shame, self-hatred, and self-deprecating behaviors, influencing self-acceptance and the expression of same-sex sexual feelings. When counseling GLB clients it is important to assess homophobic experiences and the presence of internalized homophobia.

Ethnicity and Sexual Orientation

The importance of the intersection between gay/lesbian identity and ethnic minority status cannot be overlooked. Latinos/as, African Americans or Muslim gay, lesbian or bisexual are considered a minority within a minority and experience multiple layers of oppression (Harper, Jernwall & Zea, 2004; Meyer, 1995; Parks, Hughes & Matthews, 2004). There is data supporting the fact that much of the violence, discrimination and marginalization against ethnic minority gay men and lesbians is perpetrated at the hands of their own families (Azimi, 2006; Hunter & Hickerson, 2003; Tully, 2000). Because of cultural values, fear of shaming their families and negative views of homosexuality, many gays and lesbians may hide their same-sex behaviors, and lead a double life (Hunter & Hickerson, 2003).

In ethnic groups with conservative religious or family values, the issues around coming out are more complicated. There is some indication that minority youth identity formation may be delayed (Rosario, Schrimshaw, Hunter, & Brown, 2004). The representations of homophobia and internalized homophobia have its own characteristics that are embedded in the cultural characteristics of a particular individual (Sanchez, Liu & Vilain, 2006). Gays or lesbians who belong to an ethnic minority may be less likely to come out to peers, family members, or in the workplace, leading a more isolated or ostracized life (Morales, 2006). For a Latino gay individual, for example, who wants to stay connected with his family, but has internalized the message of the injunction that machismo means “do not be like a woman”, hiding his sexual orientation from his family members may be more adaptive than coming out for fear of being rejected. Latino/a gay or lesbians may defer coming out indefinitely for fear of hurting their families or avoiding disapproval (Hunter & Hickerson, 2003; Morales, 2006).

In many Muslim countries, homosexuality is against the law and criminalized. Gay Muslims often engage in marriages of convenience or marry lesbians. This is not unusual, considering that homosexual men are often beaten, tortured, and forced to become informants of other homosexual men (Azimi, 2006). Also, because the rights of the family are considered to be above the rights of the individuals, many Muslims would not consider depriving their families of honor and pride or risk engulfing them in public shame (Azimi, 2006).

Gay men of color are often subject to racism within the gay community and may find it more difficult to find social support (Ryan & Gruskin, 2006). This added component may further compound the need to hide sexual orientation among men of color.

Suicide and Substance Abuse

It appears that gay, lesbians and bisexuals are more at risk of suicide and substance abuse than the general population. A study that included 5,000 homosexual men and women revealed that 40% of adult gay males and 39% of adult lesbians had either attempted or seriously contemplated suicide (Jay & Young as cited in McFarland, 1998). Another study reported that gay and lesbian adolescents were two to three times more likely to attempt suicide and may account for as many as 30% of completed youth suicides each year (Gibson, as cited by MacFarland, 1998). Higher rates of suicidality may be due to fear of parental rejection, lack of coping skills, exposure to homophobia, and internalized homophobia.

The GLB community is also at higher risk of substance abuse. In a study by Cochran, Ackerman, Mays, & Ross (2004), consistent patterns of elevated drug use by gay men and lesbians were found to exist. Gay men and lesbians have a higher prevalence of abuse and problems associated with illicit drugs (Cochran, Ackerman, Mays, & Ross, 2004). The most commonly used substance was marijuana, although daily use of marijuana and cocaine was found to occur more in homosexual men than compared to heterosexual men (Cochran, et al., 2004). Substance use also provides unique counseling concerns because of the increased chance for engaging in high-risk sex while using (Hirshfield, et.al., 2004). Hirshfield, et.al., (2004) reported that HIV transmission among homosexual men has increased 17% since 1999. The use of drugs to enhance sexual experiences, such as ecstasy, crystal meth, and poppers, have been associated with high-risk behaviors during sexual experiences, such as engaging in unprotected sex (Hirshfield et.al., 2004). Cheng (2003) states, “(a)lthough it has become known that lesbians and gay men have a higher rate of substance abuse compare to that of the general population, …1% of the clients in traditional substance abuse treatment programs identify themselves as being gay or lesbian” (Hellman, et. al., 1989, p.323).

Part of the reason that many in the GLB community do not seek mental health counseling or substance abuse counseling is due to homophobia. Substance use may be a way to combat tension created by external homophobia and to lessen one’s own negative feelings toward the self (Cheng, 2003). It is important to assess suicidal ideation and substance abuse in the GLB client population.

HIV

The HIV epidemic continues to devastate countless gay men and their families, friends and partners. The HIV epidemic surged through the gay community in the 1980’s, and out of 8,797 persons infected by 1985, 70% of them were gay and bisexual men (Miller, 1995) and as many as 50 to 60% of sexually active gay men tested positive for HIV. The risk factors for transmission of HIV were found to be contact with body fluids, blood or blood products, and the sharing of hypodermic needles (Miller, 1995). Currently, men who have sex with men still have the highest rates of HIV infection in the U.S. (Ryan & Gruskin, 2006). The Centers for Disease Control and Prevention reported that more than half of the HIV infections among young men in 2000 were due to same-sex contact (Ryan & Gruskin, 2006). Young adults seem to be a very high risk group, accounting for four in five cases of STDs (Ryan & Gruskin, 2006). Ryan & Gruskin (2006) discuss another high-risk group: men with same-sex partners who identify as heterosexual, particularly men of color. The Center for Disease Control and Prevention indicated in 2000 that of 8,000 men of color, up to 24% of African-American men and 15% of Latino men had same-sex partners, identified as heterosexual, and often did not disclose same-sex behaviors to their female partners (Ryan & Gruskin, 2006). When GLBs lead a double life, they are putting themselves and their partners at risk (Dube, Savin-Williams, & Diamond, 2001; Ryan & Gruskin, 2006).

It is important to assess disclosures regarding sexual orientation and the losses of a GLB in a clinical situation due to the risk of HIV infections. Many people have lost friends, partners and relatives. It is also important, therefore, to assess depression stemming from losses, and anxiety about the HIV diagnosis.

Gay and Lesbian Youth

Adolescent gays and lesbians are at higher risk of suicide, substance use and abuse and homelessness than their heterosexual peers (Hunter & Hickerson, 2003). Factors such as disrupted peer relationships, family conflict around disclosure of sexual orientation, struggles with GLB sexual identity, feelings of isolation, being a target for discrimination, harassment, and violence due to sexual orientation, and having anxiety about sexual health are all stressors that could contribute to a GLB youth’s risks. One study found that gay and lesbian adolescents accounted for up to 30% of completed youth suicides per year, and were two to three times more likely to attempt suicide than their heterosexual peers (McFarland, 1998; Hunter & Hickerson, 2003).

Reasons for homelessness include being expelled from the home by parents and running away from home (Hunter & Hickerson, 2003). Studies in Los Angeles and Seattle estimate between 25 and 40 percent of runaway and homeless youth to be gay (Hunter & Hickerson, 2003). Hunter & Hickerson (2003) cite studies that indicate the additional risks of being homeless for these youth such as, “they are likely to be overtaken by assaults and sexual exploitation, drug usage, prostitution, pregnancy, criminal activity, or HIV” (p. 325). A study by Rotheram-Borus and colleagues found that GLB youth subjects compared to subjects in national surveys had lifetime prevalence rates of substance use that were 50% higher for alcohol, three times higher for marijuana, and eight times higher for cocaine or crack (as cited in Hunter & Hickerson, 2003). Compound the homelessness of GLB youth and substance use, and the findings are even more devastating. In a study by Shifrin & Solis of 72 homeless gay youth and 3 homeless lesbian youth, 100 percent were addicted to crack or cocaine. Hunter & Hickerson (2003) state, “(c)hemicals numb anxiety and depression and act as an antidotes to the pain of exclusion, ridicule, and rejection” (p. 326).

A major drawback of citing these statistics is that the information focuses on the negative aspects of GLB youth, giving the impression that homosexuality invariably leads to unhappiness, suffering, distress and psychopathology and not giving a full account of the characteristics of this population (Miceli, 2002). Many GLB youth are politically active, fighting stigma and homophobia, and organizing grassroots movements in schools and other institutions. This activity has the effect of educating GLB youth and results in resilient and strong young men and women. The current viewpoint is that although there are certain risk factors for GLB youth, overall most are able to manage their lives well (Hunter & Hickerson, 2003). Rotheram-Borus & Langabeer (2001) suggest that a shift toward positive attitudes toward GLB individuals in mainstream culture may be helpful in alleviating societal pressures in GLB youth. This in turn can empower these individuals as they work through their coming out issues as they may feel more supported by others in society. Designing programs that help to lessen or remove the stigma of GLB identities could be an important factor in supporting GLB youth (Rotheram-Borus & Langabeer, 2001). Identifying risk factors and addressing these in support groups for GLB youth could be another way to allow for positive identification and acceptance for GLB youth (Hunter & Hickerson, 2003).

Human Rights Issues

Another issue of importance when working with gay and lesbian clients is the issue of human rights and legal rights. Gay men and lesbians face discrimination in various arenas including employment, housing, the military, immigration, student organizations, child custody, and personal relationships (Hunter & Hickerson, 2003); many states still have sodomy laws that restrict consensual sex acts between adults (Hunter & Hickerson, 2003). Knowing about federal, state and local laws that may restrict gay and lesbian clients is important when helping GLB clients. Counselors must also be prepared to advocate for their clients and their clients’ rights from a human rights perspective.

GLB Client/Clinician Match

Research on GLB client/counselor match is contradictory and inconclusive. Many GLB clients prefer a counselor of the same sexual orientation. Kaufman & Carlozzi (1997) found that the importance of having a counselor with the same sexual orientation as well as the same gender of the counselor was more prominent for lesbians than for gay men or bisexuals. The importance of the sexual orientation of the counselor may depend on the presenting issues for counseling. For issues regarding sex-related problems it may be more important to have a match than for issues such as work-related problems (Kaufman & Carlozzi, 1997). McDermott, Tyndall, & Lichtenberg (1989), found that 49% of their sample indicated a preference for a counselor of the same sexual orientation, yet 39% reported that sexual orientation of the counselor made no difference.

When working with GLB clients, counselors need to be aware of the process of coming out and the never-ending process of disclosure (Hunter & Hickerson, 2003; Morrow, 2006). Indication of a good match for GLB clients is a counselor who can provide a safe and nonjudgmental place for GLB clients to work through their feelings; openness and complete confidentiality on the part of the counselor and counselors’ awareness of community services and resources specific to the GLB community (Hunter & Hickerson, 2003). Sensitivity to the unique concerns of GLB individuals and knowledge of GLB relationships and family issues is also instrumental for a good client/clinician match.

Gay and Lesbian Couples and Families

Gay and lesbian couples and families have unique needs and concerns. Lesbian women and gay men are engaged in long-term relationships, having babies, and creating families redefining commitments and what families can be. Since the 1970’s, there has been a substantial increase in the number of children raised by gay and lesbian parents (Bowe, 2006). With few models to draw upon, these couples and families often need the services of clinicians to help them navigate the complicated legal, social and emotional issues they face in a society that bans or shuns gay marriage and may discriminate against the children of gay couples. Often in the case of gay or lesbian parents who previously had children in a heterosexual marriage, it can be difficult to secure custody or even visitation rights, especially in the case of gay men (Hunter & Hickerson, 2003). The strain and discrimination experienced by gay and lesbian parents as well as the loss of family and contact with their children would be important to explore with these clients.

One aspect of heterosexism is the denial by mental health professionals of the unique needs and concerns of GLB individuals, and the insistence of approaching GLB clients with a heterosexist bias (Hunter & Hickerson, 2003), as if there were no differences. When looking at gay and lesbian relationships, counselors will need to examine their own beliefs about gender roles, for example (Moses, 1982). While some GLB couples may be comfortable conforming to gender-typed behaviors and play opposite gender roles, others may differ from traditional heterosexual expectations (Moses, 1982; Morrow, 2006). A counselor who looks at a gay relationship from a heterosexist viewpoint may feel that a couple should fit into opposite gender roles, and frustrate clients who do not view themselves in a specific gender role within the relationship. Hunter & Hickerson (2003) point out that gay and lesbian couples receive little or no validation for their relationships or their families due to heterosexist notions and disapproval of same-gender relationships. Another heterosexist assumption is that both parents are legal guardians of their child. Many times in gay and lesbian relationships, only one parent is the legal guardian and the other parent may have no legal rights (Hunter & Hickerson, 2003). Gay and lesbian parents often have less support from their communities than do heterosexual couples (Hunter & Hickerson, 2003). This can lead these families to feel isolated physically and emotionally.

Overall, research has shown that children of gay and lesbian parents experience no significant distinctions or disadvantages when compared to children with heterosexual parents. A study of lesbian and gay stepfamilies found that there were, “…unique strengths and flexibility in discovering creative ways to be families that nourish and support all members” (Lynch as cited in Hunter & Hickerson, 2003, p. 180). Patterson’s study of 37 children with lesbian mothers indicated that these children were normal in their social competencies and self-concept, and their sex-gender role behaviors were considered to be typical when compared to normative samples (as cited in Hunter & Hickerson, 2003). In another study by Tasker & Golombok that followed children of lesbian mothers for 25 years, there were no significant differences in mental health difficulties experienced by these individuals as compared to children of heterosexual mothers (as cited in Hunter & Hickerson, 2003). As stated by McKinney (2006), “Children from gay and lesbian families tend to be more tolerant of others, less judgmental, and more open to new experiences than children reared in heterosexual families” (p. 208).

Social Support

Counselors can help locate sources of social support for parents of GLB children. Organizations such as Parents, Families, and Friends of Lesbians and Gays (PFLAG) can provide parents the opportunities for networking with other parents and gaining a greater understanding of and comfort with their GLB children (Hunter & Hickerson, 2003). Other organizations, such as the Human Rights Campaign (HRC), provide resources for parents, families, and GLB individuals (Morrow, 2006). Connecting parents with these resources and forms of social support can help to lessen feelings of isolation that they may experience. Other referrals for parents could be anger management groups and groups that help develop techniques for resolving disputes and stilted communication (Hunter & Hickerson, 2003). It may also be helpful to approach the child’s coming out as GLB as a loss for the parent; therefore using stages of grief as a model for working through the parent’s emotional responses (Hunter & Hickerson, 2003). Availability and use of social support of GLB clients and their families is correlated with better mental health.

Obviously not all GLB individuals suffer from depression, anxiety, suicidal or other mental health issues. With all the oppression, heterosexism, homophobia that GLB clients face, what helps them to lead happy and productive lives? Perhaps one of the biggest signs of resiliency in the GLB community was the birth of the gay liberation movement in 1969. The GLB community fought back against continual police oppression that resulted in a series of riots known as the Stonewall Rebellion which symbolized the growing voice of the gay community; they would no longer live in secrecy and silence (Tully, 200). The lambda sign (a symbol used by the gay community) means ‘dignity in the face of oppression’ (Tully, 2006, p. 31). The gay community continued the work of liberation by lobbying to have homosexuality removed from the Diagnostic and Statistic Manual of Mental Disorders, and finally achieved this by the 1987 printing of the DSM-III-TR (Hunter & Hickerson, 2003).

Currently GLB individuals and couples are lobbying for marriage rights and the rights to adopt children. Many are having children and starting their own families. Anti-discrimination laws for workplace, housing, and education are being passed as a result of the GLB community’s efforts for their basic human rights (Hunter & Hickerson, 2003). Community centers in urban areas have been established, as well as mental health centers and medical centers. The GLB community has put forth enormous efforts in the face of the oppression that they endured, and through the formation of advocacy groups, social support groups, and social service centers, they persevere and thrive (Hunter & Hickerson, 2003).

Implications for Professionals

Clinicians might work with GLB clients directly or with their siblings, parents, spouses or their children and should be aware of the preceding clinical issues. Professionals need to be comfortable making assessments, asking appropriate questions and providing help in finding support. Counselors need to be aware of state regulations and ethical guidelines regarding exceptions to confidentiality around issues of HIV/AIDS disclosures to third parties and that there are multiple pathways toward the successful synthesis of an individual’s sexual identity.

This sub-section includes the story of Karen

Discussion Questions

1. What are the differences between sexual orientation and gender socialization?
2. What are the differences between gender socialization, gender identity and gender expression?
3. In your view, how important is it to understand the origins of sexual orientation?
4. How important is it to have a GLB client/GLB clinician match in your view? Are your reasons the same or different than arguing for and ethnic client/counselor match?
5. What steps could you take to increase your level of comfort to work with a GLB client?