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Affirmative Practice and Alternative Sexual Orientations: Helping Clients Navigate the Coming Out Process

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Abstract

Those who differ from the dominant heterosexual ideal of exclusively other-sex attraction and intimacy encounter unique challenges, such as the coming out process, during which individuals with alternative sexual orientations must explore, define, and disclose their orientations in a way straight individuals need not. This article focuses on how clinicians can aid clients throughout the coming out process in a way that affirms the full range of sexual orientations. Following an overview of alternative sexual orientations and models of the coming out process, a case example is used to illustrate how clinicians can help clients address three challenges of coming out: overcoming internalized biases; clarifying their sexual orientation and identity; and making decisions about disclosure.

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Notes

  1. There is diversity in biological sex not captured in the male–female dichotomy, including physiological and chromosomal variations; these are beyond the scope of this article. Dichotomous language is used to discuss biological sex because current conceptualizations of sexual orientation assume two (opposite) sexes.

References

  • Beckstead, L., & Israel, T. (2007). Affirmative counseling and psychotherapy focused on issues related to sexual orientation conflicts. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 221–244). Washington, DC: American Psychological Association.

    Google Scholar 

  • Bieschke, K. J., Paul, P. L., & Blasko, K. A. (2007). Review of empirical research focused on the experience of lesbian, gay, and bisexual clients in counseling and psychotherapy. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 293–315). Washington, DC: American Psychological Association.

    Google Scholar 

  • Bogaert, A. F. (2004). Asexuality: Its prevalence and associated factors in a national probability sample. The Journal of Sex Research, 41(3), 279–287.

    Article  Google Scholar 

  • Bogaert, A. F. (2006). Toward a conceptual understanding of asexuality. Review of General Psychology, 10(3), 241–250.

    Article  Google Scholar 

  • Broido, E. M. (2000). Constructing identity: The nature and meaning of lesbian, gay, and bisexual identities. In R. M. Perez, K. A. DeBord, & K. J. Bieschke (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients (pp. 13–33). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Butler, J. (1999). Gender trouble (2nd ed.). New York: Routledge.

    Google Scholar 

  • Cass, V. C. (1984). Homosexual identity formation: Testing a theoretical model. Journal of Sex Research, 20(2), 143–167.

    Article  Google Scholar 

  • Cochran, S. D., & Mays, V. M. (2006). Estimating prevalence of mental and substance-using disorders among lesbians and gay men from existing national data. In A. M. Omoto & H. S. Kurtzman (Eds.), Sexual orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people (pp. 143–165). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Cohen, K. M., & Savin-Williams, R. C. (1996). Developmental perspectives on coming out to self and others. In R. C. Savin-Williams & K. M. Cohen (Eds.), The lives of lesbians, gays, and bisexuals: Children to adults (pp. 113–151). Orlando, FL: Harcourt Brace College Publishers.

    Google Scholar 

  • Coleman, E. (1985). Developmental stages of the coming out process. In J. C. Gonsiorek (Ed.), A guide to psychotherapy with gay and lesbian clients (pp. 31–43). New York: Harrington Park Press.

    Google Scholar 

  • Crisp, C. (2006). The gay affirmative practice scale (GAP): A new measure for assessing cultural competence with gay and lesbian clients. Social Work, 51(2), 115–126.

    PubMed  Google Scholar 

  • Crisp, C., & McCave, E. L. (2007). Gay affirmative practice: A model for social work practice with gay, lesbian, and bisexual youth. Child and Adolescent Social Work Journal, 24, 403–421.

    Article  Google Scholar 

  • D’Augelli, A. R. (2006). Developmental and contextual factors and mental health among lesbian, gay, and bisexual youths. In A. M. Omoto & H. S. Kurtzman (Eds.), Sexual orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people (pp. 37–53). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Diamond, L. M. (2006). What we got wrong about sexual identity development: Unexpected findings from a longitudinal study of young women. In A. M. Omoto & H. S. Kurtzman (Eds.), Sexual orientation and mental health: Examining identity and development in lesbian, gay, and bisexual people (pp. 73–94). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Dworkin, S. H. (2000). Individual therapy with lesbian, gay, and bisexual clients. In R. M. Perez, K. A. DeBord, & K. J. Bieschke (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients (pp. 157–181). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Eubanks-Carter, C., Burckell, L. A., & Goldfried, M. R. (2005). Enhancing therapeutic effectiveness with lesbian, gay, and bisexual clients. Clinical Psychology: Science and Practice, 12(1), 1–18.

    Article  Google Scholar 

  • Fassinger, R. E., & Arseneau, J. R. (2007). “I’d rather get wet than be under than umbrella”: Differentiating the experiences and identities of lesbian, gay, bisexual, and transgender people. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 19–49). Washington, DC: American Psychological Association.

    Google Scholar 

  • Fassinger, R. E., & Miller, B. A. (1996). Validation of an inclusive model of sexual minority identity formation on a sample of gay men. Journal of Homosexuality, 32(2), 53–78.

    Article  PubMed  Google Scholar 

  • Firestein, B. A. (2007). Cultural and relational contexts of bisexual women: Implications for therapy. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 91–117). Washington, DC: American Psychological Association.

    Google Scholar 

  • Greene, B. (2007). Delivering ethical psychological services to lesbian, gay, and bisexual clients. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 181–199). Washington, DC: American Psychological Association.

    Google Scholar 

  • Haldeman, D. C. (2005). Psychotherapy with gay and bisexual men. In G. E. Good & G. R. Brooks (Eds.), The new handbook of psychotherapy and counseling with men: A comprehensive guide to settings, problems, and treatment approaches (pp. 369–383). San Francisco: Jossey-Bass.

    Google Scholar 

  • Haldeman, D. C. (2007). The village people: Identity and development in the gay male community. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 71–89). Washington, DC: American Psychological Association.

    Google Scholar 

  • Hershberger, S. L., & D’Augelli, A. R. (2000). Issues in counseling lesbian, gay, and bisexual adolescents. In R. M. Perez, K. A. DeBord, & K. J. Bieschke (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients (pp. 225–247). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Hollander, G. (2000). Questioning youths: Challenges to working with youths forming identities. School Psychology Review, 29, 173–179.

    Google Scholar 

  • Katz, J., Joiner, T. E., Jr., & Kwon, P. (2002). Membership in a devalued social group and emotional well-being: Developing a model of personal self-esteem, collective self-esteem, and group socialization. Sex Roles, 47(9/10), 419–431.

    Article  Google Scholar 

  • Langdridge, D. (2008). Are you angry or are you heterosexual? A queer critique of lesbian and gay models of identity development. In L. Moon (Ed.), Feeling queer or queer feelings? Radical approaches to counseling sex, sexualities and genders (pp. 23–35). New York: Routledge.

    Google Scholar 

  • LaSala, M. (2006). Cognitive and environmental interventions for gay males: Addressing stigma and its consequences. Families in Society, 87(2), 181–189.

    Google Scholar 

  • Malley, M., & Tasker, F. (2007). “The difference that makes a difference”: What matters to lesbians and gay men in psychotherapy. Journal of Gay & Lesbian Psychotherapy, 11(1/2), 93–109.

    Article  Google Scholar 

  • Matthews, C. R. (2007). Affirmative lesbian, gay, and bisexual counseling with all clients. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 201–219). Washington, DC: American Psychological Association.

    Google Scholar 

  • McCarn, S. R., & Fassinger, R. E. (1996). Re-visioning sexual minority identity formation: A new model of lesbian identity and its implications for counseling and research. The Counseling Psychologist, 24(3), 508–534.

    Article  Google Scholar 

  • McPhail, B. A. (2004). Questioning gender and sexual binaries: What queer theorists, transgendered individuals, and sex researchers can teach social work. Journal of Gay & Lesbian Social Services, 17(1), 3–21.

    Article  Google Scholar 

  • Meyer, I. H. (2003). Minority stress and mental health in gay men. In L. D. Garnets & D. C. Kimmel (Eds.), Psychological perspectives on lesbian, gay, and bisexual experiences (2nd ed., pp. 699–731). New York: Columbia University Press.

    Google Scholar 

  • NASW. (2000). Position statement: “Reparative” and “conversion” therapies for lesbians and gay men. Retrieved February 5, 2009 from http://www.socialworkers.org/diversity/lgb/reparative.asp.

  • National Association of Social Workers. (2008). Code of ethics. Retrieved December 7, 2008, from http://www.socialworkers.org/pubs/Code/code.asp.

  • Pachankis, J. E., & Goldfried, M. R. (2004). Clinical issues in working with lesbian, gay, and bisexual clients. Psychotherapy: Theory, Research, Practice, Training, 41(3), 227–246.

    Article  Google Scholar 

  • Perez, R. M., & Amadio, D. M. (2004). Affirmative counseling and psychotherapy with lesbian, gay, and bisexual clients. In C. Negy (Ed.), Cross-cultural psychotherapy: Toward a critical understanding of diverse clients (pp. 301–325). Reno, NV: Bent Tree Press.

    Google Scholar 

  • Phillips, S. H., Richardson, J., & Vaughan, S. C. (2005). Sexual orientation and psychotherapy. In G. O. Gabbard, J. S. Beck, & J. Holmes (Eds.), Oxford textbook of psychotherapy (pp. 421–430). Oxford, UK: Oxford University Press.

    Google Scholar 

  • Potoczniak, D. J. (2007). Development of bisexual men’s identities and relationships. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed., pp. 119–145). Washington, DC: American Psychological Association.

    Google Scholar 

  • Prause, N., & Graham, C. A. (2007). Asexuality: Classification and characterization. Archives of Sexual Behavior, 36, 341–356.

    Article  PubMed  Google Scholar 

  • Reynolds, A. L., & Hanjorgiris, W. F. (2000). Coming out: Lesbian, gay, and bisexual identity development. In R. M. Perez, K. A. DeBord, & K. J. Bieschke (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients (pp. 35–55). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Rothblum, E. D. (2000). Sexual orientation and sex in women’s lives: Conceptual and methodological issues. Journal of Social Issues, 56(2), 193–204.

    Article  Google Scholar 

  • Rust, P. C. (2003). Finding a sexual identity and community: Therapeutic implications and cultural assumptions in scientific models of coming out. In L. D. Garnets & D. C. Kimmel (Eds.), Psychological perspectives on lesbian, gay, and bisexual experiences (2nd ed., pp. 227–269). New York: Columbia University Press.

    Google Scholar 

  • Savin-Williams, R. C., & Ream, G. L. (2007). Prevalence and stability of sexual orientation components during adolescence and young adulthood. Archives of Sexual Behavior, 36(3), 385–394.

    Article  PubMed  Google Scholar 

  • Scherrer, K. S. (2008). Coming to an asexual identity: Negotiating identity, negotiating desire. Sexualities, 11(5), 621–641.

    Article  Google Scholar 

  • Troiden, R. R. (1989). The formation of homosexual identities. In G. Herdt (Ed.), Gay and lesbian youth (pp. 43–73). New York: Haworth Press.

    Google Scholar 

  • Weinberg, M. S., Williams, C. J., & Pryor, D. W. (1994). Dual attraction: Understanding bisexuality. New York: Oxford University Press.

    Google Scholar 

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  1. BayRidge Hospital, Lynn, MA, 60 Granite Street, Lynn, MA, 01904, USA

    Natalie L. Hill

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  1. Natalie L. Hill
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Correspondence to Natalie L. Hill.

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Hill, N.L. Affirmative Practice and Alternative Sexual Orientations: Helping Clients Navigate the Coming Out Process. Clin Soc Work J 37, 346–356 (2009). https://doi.org/10.1007/s10615-009-0240-2

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  • DOI: https://doi.org/10.1007/s10615-009-0240-2

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