(Adolescence)
In a culture already uncomfortable about adult sex and worried about
adolescent sexual behavior, the idea of homosexual sex generates hostile
and almost reflexive contempt. Society's abhorrence, and hence avoidance,
of homosexuality is reflected in the dearth of articles in the professional
literature of counseling and psychology. From 1978-1989, only 43 of
6,661 articles published in six major psychological journals addressed
gay and lesbian issues (Buhrke, Ben-Ezra, Hurley, & Ruprecht, 1992).
This omission is even more striking when reviewing literature on adolescent
homosexuality. For example, from 1977 to 1993, only three articles
on gay and lesbian adolescents were published in The School Counselor,
the primary professional journal for a counseling group which has
access to the entire population of adolescents. This neglect coupled
with lack of coverage in counselor preparation programs (Buhrke, 1989;
Bodnar & Fontaine, 1993; Graham, Rawlings, Halpern, & Hermes, 1984)
essentially precludes professionals from receiving adequate preparation
for ethical and competent counseling of gay, lesbian, and bisexual
adolescents.
That the need for this training exists is well documented. Although
the American Psychiatric Association depathologized homosexuality
in 1973 by removing it from the Diagnostic and Statistical Manual
list of psychological disorders, and the American Psychological Association
acted similarly in 1975, psychologists have maintained resistance
to this new perspective. A recent survey of psychologists found that
nearly 30% of responding clinicians felt that treating homosexuality
per se as pathological constituted ethical practice (Pope, Tabachnick,
& Keith-Spiegel, 1987). A study of heterosexual bias in counselor
trainees determined that 83% of participants assumed client heterosexuality
when given ambiguous conditions (Glenn & Russell, 1986).
What do counselors need to know in order to work effectively with
sexual minority adolescents? Pederson (1988) identifies a tripartite
approach to diversity training which begins with awareness of the
counselor's own attitudes and beliefs, moves into the acquisition
of knowledge, and then toward the final stage of skill acquisition.
Effective counseling with homosexually oriented youth or those questioning
their sexual identity cannot happen if the provider has not first
come to terms with his or her own feelings and attitudes about homosexuality.
While not addressed in this article, we believe it is incumbent upon
the professional to address this issue.
This articles goes beyond Zera's (1992) efforts to outline the developmental
struggles of gay and lesbian adolescents. Stages of identity development
are presented along with suggested intervention strategies. Also included
is a perspective on the components of sexual orientation in order
to guide the practitioner in assisting adolescents to more completely
address the struggle of exploring and clarifying their sexual orientation.
Identity Development for Lesbian and Gay Adolescents
Like their heterosexual counterparts, gay and lesbian adolescents
share the same physical, cognitive, psychological, and social tasks
of development, many of which are unaffected by issues of sexual orientation.
However, since one of the major psychological tasks of adolescence
is that of identity formulation and consolidation, the gay, lesbian
or bisexual adolescent faces myriad challenges that the heterosexual
adolescent does not.
The various components of any individual's identity include the sense
of who one is as a sexual being, i.e., a sexual identity. Several
processes by which an adolescent clarifies and consolidates this particular
sense of self are cohort comparisons, societal confirmation, and peer
affirmation. Environmental systems such as school, family, neighborhood,
and work setting assist in this process. For the adolescent struggling
with a sense of undefined "differentness" regarding the focus of his
or her sexual attractions, these typical avenues and resources for
sexual identity clarification and healthy formation are frequently
unavailable at best. More likely, however, they present a negative
and stigmatizing backdrop against which the adolescent must explore
feelings and thoughts about this highly personal and integral aspect
of personal identity. In schools, it is commonplace for students to
routinely apply the words "faggot," "gay," "dyke," or "queer" to anyone
they dislike for any reason, highlighting the devaluing of anything
associated with being gay. Nor can support be expected from family
and friends since it is likely that they have expressed antagonistic
attitudes toward homosexuality at some point in the past.
The cost of this stigmatization becomes all too apparent in statistics
which reflect disproportionate frequencies of psychological disturbance
among gay and lesbian teens. Runaways, substance abuse, depression,
anxiety, suicide attempts, and prostitution have been evidenced by
this group in higher proportions than by nonhomosexual youth (Jay
& Young, 1979; Bell & Weinberg, 1978; Hetrick & Martin, 1987; Remafedi,
1987a). Gibson (1989), in a project funded by the U.S. Department
of Health and Human Services, found that 30% of completed teen suicides
were committed by youth dealing with sexual identity issues.
Estimates are that 10% of the population may be gay and lesbian which
means one of every five families has a gay or lesbian child (Dahlheimer
& Feigal, 1991). Hence, the population directly affected by the issues
of gay and lesbian teens becomes geometrically larger, including parents,
siblings, and other relatives who may experience the emotional consequences
of maintaining family secrecy over having a homosexual family member.
Gay, Lesbian, and Bisexual Identity Formation
It is apparent that gay men and lesbians do not suddenly "appear"
in adulthood. Many more adolescents will question their sexual identity
than will actually come to define themselves as gay, lesbian or bisexual.
The task of differentiating and providing meaning to sexual feelings
and experiences during adolescence becomes a confusing one. Compared
to the "development" of a heterosexual identity, a norm requiring
little conscious thought or effort, the attempt to develop a healthy
and viable bi- or homosexual identity is a draining, secretive, anxiety-
producing, and lonely task for adolescents. Hetrick and Martin (1987)
found that the primary presenting problem for gay and lesbian adolescents
was one of both social and emotional isolation and loneliness which,
at times, initiated sexual involvement with same sex adults simply
from a need for some type of social contact.
It is highly likely that the process of claiming a gay or lesbian
identity may not be completed during adolescence. This process also
may not be attached to demonstrative homosexual behavior for many
youth. At the same time, due to the lack of a supportive discernment
process, many gay and lesbian youth believe they have to directly
experience a same-sex encounter to prove to themselves that they are
gay. Such beliefs put lesbian and gay teens at considerable risk for
inappropriate sexual contact.
Evidence supports both gender and age differences in how males and
females come to know they are gay (Bell, Weinberg, & Hammersmith,
1981; Gorsiorek, 1988; Remafedi, 1987b). For both, however, the self-
identification occurs over a long period characterized by extreme
emotional turmoil. There are several models of this process of sexual
identity formation which can assist the clinician in understanding
the sequence of this self-labeling or coming-out process (Cass, 1979;
Lewis, 1984; Troiden, 1989). All share the commonality that each stage
moves toward an increasing level of acceptance of a homosexual identity.
A progression from confusion, through exploration, to synthesis or
integration is outlined in all three.
In the most well known of these models, Cass (1979) identifies six
stages of identity formation: Confusion, comparison, tolerance, acceptance,
pride, and synthesis. In Stage 1, identity confusion, heterosexual
identity is called into question and the teen wonders "Could I be
homosexual?" Gay and lesbian information or awareness becomes personally
relevant, and the heterosexual assumption begins to be undermined.
At this stage, confusion is great and the adolescent may seek information
on homosexuality, a difficult task given the inaccessibility of such
information. For example, school librarians often report that, if
permitted, books on gays and lesbians in their libraries often "disappear"
from the shelves without being checked out.
Counseling interventions at this stage could assist the teen to redefine
differentness, discourage premature labeling, and attempt to normalize
feelings. Denial is a primary defense at this stage. The teen may
attempt to prematurely foreclose on the development process if not
provided an accepting environment in which to explore the possibility
of gay, lesbian or bisexual identity.
Identity comparison, Stage 2, begins with accepting the potential
that homosexual feelings are a part of the self. The realization that
"I might be homosexual" may cross the teen's mind. Alternately, a
re-framing of same-gender sexual attractions as a special case (it
just happens to be this one person I am attracted to and he/she happens
to be the same sex) may occur. The idea that "I may be bisexual" (which
permits the potential for heterosexuality) can also be a manifestation
of Stage 2 identity development. It is also at this level that "This
is a 'phase' I'm going through" may surface. For some youth, there
is a personal responsibility void where the cognitive stance is just
"being born" that way (Cass, 1979). These strategies are developed
to reduce the incongruence between same-sex attractions and a view
of one's self as heterosexual.
The task at this stage of identity comparison, according to Cass,
is to deal with social alienation as the teen becomes aware of his
or her difference from larger society, experiences a sense of not
belonging and the isolation of perceiving himself or herself as an
isolated case; that is, the only one "like this." Hersch (1991) presents
a poignant interview with a 14-year-old girl at this stage of development
which underlines the emotional turmoil. She quotes Sarah, "I don't
understand what is going on with me . . . I want to kill myself. I'
m scared of who I am. There is no one else like me. It's not normal
to be gay" (p. 38). Counselors dealing with clients at this developmental
level can explore their fears and anxieties, attempt to identify role
models and, where possible, locate healthy and appropriate support
systems such as peer support groups or drop-in centers.
Identity tolerance, Stage 3, is marked by such statements as "I probably
am homosexual." The individual has moved further from a heterosexual
identity and more toward a homosexual one. This may include seeking
out the company of homosexuals to meet psychosocial needs. This movement
helps dispel the sense of confusion and turmoil of prior stages, but
creates a greater gulf in the comparison between self and others.
For the adolescent who experiences a heightened need for peer approval
and acceptance, this can be a dramatically trying period. At the time
when merely failing to acquire an opposite-gender girlfriend or boyfriend
or wearing the wrong kind of clothing can be decisive in falling from
heterosexual grace, the homosexual teen is forced to scrutinize every
action to maintain his or her secret. Adolescents attempting to dissipate
the dissonance of identities may adopt an asexual role or practice
covert homosexual behavior, which is particularly dangerous given
the impulsive nature of sexual contacts and the high incidence of
HIV infection among adolescent males. Positive gay experiences are
crucial to developing a degree of self-acceptance (vs. self-hatred)
during this period. Contacting other gay, lesbian, and/or bisexual
people becomes a more pressing issue to alleviate a sense of isolation
and alienation. Counseling interventions at this stage can assist
in interpreting negative experiences, developing interpersonal skills,
addressing fears of exposure, facilitating decision making on coming
out, and offering insight on the identity formation process as well
as resource information.
Stage 4, identity acceptance, involves increasing contact with other
gays and lesbians and developing a more clearly delineated homosexual
identity. Finding other gay and lesbian teens is difficult at best
for many adolescents. Those in rural areas often find the social isolation
nearly unbearable. Many of these young people feel a need to leave
home and school and move to an urban area simply to make contact with
other gay people. Those adolescents fortunate enough to have access
to support groups and/or gay social events often heighten their dual
lifestyle existence, being heterosexual publicly and bi- or homosexual
privately as the fear of being "discovered" permeates their existence.
The issues of "who am I?" and "how do I fit in?", however, have begun
to be addressed.
Stages 5 and 6, identity pride and identity synthesis, move the individual
from a "them and us" mentality into a realization and acceptance of
the similarities between the heterosexual and homosexual worlds. Strong
identification with the gay subculture and devaluation of heterosexuality
and many of its institutions (Stage 5) gives way to less rigid, polarizing
views and more inclusive and cooperative behavior (Stage 6). Table
1 provides an overview of these stages with suggested counseling interventions.
These latter two stages, pride and synthesis, are particularly difficult
for school-aged adolescents to achieve, given the basic reality of
their life circumstances. In this regard, lesbian and gay adolescents
have the same needs for economic, physical, and emotional dependence
and nurturance from parents as do heterosexual adolescents.
Placing a gay or lesbian identity into appropriate perspective, as
a part of an overall total identity, is made particularly difficult
for several reasons. Society's focus on the sexual behavior component
of a homosexual orientation, excluding feelings of attraction, love,
companionship, and subcultural mores, encourages the perpetuation
of inaccurate sexual myths and stereotypes. For example, the myths
that anonymous sexual liaisons are the only recourse for gay males,
or that lesbians are a danger to children, derive from an exclusionary
focus on the sexual behavior component of homosexual orientation.
Adolescence in general is a time of natural heightened interest in
sexuality - for both heterosexual and homosexual youth. The adolescent
can easily be overwhelmed with an amplified version of sex as the
primary component in a homosexual's life, versus one of the many aspects
of identity.
Sexual Orientation: More than Sexual Behavior
Adolescent mental health workers and school guidance counselors have
the opportunity to make a substantial positive impact in the lives
of teens uncertain about their sexual orientation simply by conveying
the reality that orientation goes beyond sexual impulse or behavior.
For example, a confused adolescent may believe that a single sexual
contact of any sort defines sexual identity. Appropriate counseling
encourages the young person to consider the meaning of daydreams,
affectional patterns, unexpressed physical attractions, and emotional
responses in sorting through issues of sexual orientation.
As noted earlier, many adolescents who question their sexual orientation
will not develop a gay or lesbian identity. This confusion may be
initiated by such behaviors as deviation from traditional gender roles,
the occurrence of same-gender sexual fantasies, and/or attractions
and incidents of same-gender sexual contact. The subsequent homosexual
"panic" these behaviors can generate needs to be assessed within the
context of the behavioral precipitants and the identity stages outlined
earlier. The apparent fact that same-sex sexual behavior is relatively
common (Kinsey, Pomeroy, & Martin, 1948) should also be kept in mind.
Adolescent emotional liability and the very lack of accurate information
about homosexuality often exacerbates an adolescent's fear. However,
to dismiss the fantasies and the same-sex intimate behavior with
an explanation that it is a "phase," or to prematurely foreclose on
an adolescent's acceptance of his or her own gay or lesbian identity,
are equally invalid and harmful courses of action. Again, assisting
teens to explore their prior sexual attractions and fantasies, differentiating
between sexual orientation and gender roles, and providing literature
to assist in the exploration of these questions can normalize the
process and diminish their reactive fear. Above all, counselors need
to recognize that for many teens, sexuality is an area of flux, and
the process of arriving at an established sexual orientation can take
months or years.
Sexual orientation includes a complex set of components. Coleman (1990)
utilizes a nine-item questionnaire to help clients gain an appreciation
for the complexity of sexual orientation, as well as assess various
aspects of their current status. Clients respond to items that question,
for example, to whom one is attracted and which sex one fantasizes
or dreams about, utilizing a five-point scale from male to female.
Adolescents can also benefit from differentiating between such issues
as sexual preference and gender role, since many believe that gay
males are effeminate and lesbians masculine (Paroski, 1990).
Hindrances to Treatment
Because of the current stigma surrounding everything associated with
homosexuality, it is unlikely that the majority of affected adolescents
will present themselves for treatment with issues related to their
sexual identity. Coleman and Remafedi (1989) believe that most teenagers,
even those seriously questioning their sexual identity, will identify
as heterosexual until there is compelling evidence to the contrary.
One study found that 40% of homosexual adolescent males interviewed
had sought prior psychiatric treatment, but did not necessarily disclose
their sexual orientation at the time (Remafedi, 1987a). More likely,
[TABULAR DATA FOR TABLE 1 OMITTED] gay and lesbian adolescents maintaining
their "secret" will be mixed among those in treatment through two
sources: Those mandated by legal or institutional authorities (e.g.,
runaways, substance abusers, truants), and those seeking services
for more traditional psychological problems (e.g., depression, school
phobia, suicide attempts). It is only with an awareness of sexual
orientation as a possible precipitator of unacceptable or apparently
pathological behavior that the sensitive service provider can choose
to explore sexual orientation.
Hetrick and Martin (1987), in one of the few studies on the types
of problems presented by self-identified gay and lesbian youth, found
the major reason for seeking service was a sense of extensive isolation
- from family, social networks, and peers. This isolation was magnified
by the lack of access to accurate information about homosexuality.
The problem may be compounded for adolescents of color, with the resurgence
of belief in some segments of minority communities that all gay people
are white. Indeed, the presentation of gay issues by activists within
the gay community often highlights the concerns of Caucasian middle-
class gay and lesbian adults. Young African-American, Native American,
Asian American, Hispanic and other minority adolescents face identity
barriers on many fronts simultaneously.
Family problems were the second most frequent area of concern cited
by Hetrick and Martin. Difficulties ranged from parental rejection
to violence and expulsion from the home. Coming out to parents is
perhaps one of the more serious issues in the coming out process.
Counselors should assist adolescents in fully exploring their reasons
for coming out to parents before making a decision to act. Such questions
as availability of alternative resources, parents' moral views, motivation
for coming out at the time, and the current emotional climate at home,
should be addressed. The adolescent will also need to be aware that
patience may be required as many parents will have to undergo their
own "coming out" process with the information shared by their child.
Drug use was evidenced by 5% of the Hetrick and Martin sample, emotional
problems such as depression and anxiety in approximately 19%, and
suicide attempts by 20% of those seeking advice. It is interesting
to note that suicide completions and attempts by adolescents decrease
with age (Bell & Weinberg, 1978; Saghir & Robins, 1973; Hetrick &
Martin, 1987). This decrease is thought to be related to the increased
freedom of movement and attendant diminished sense of isolation which
occurs for older teens.
Coming Out Issues
For the adolescent coming to terms with the fact that he or she might
be gay or lesbian, the process of accepting oneself is intertwined
with the decision to inform others. Professionals should be thoughtful
of the potential costs and consequences of an adolescent's decision
to come out to others, particularly parents. There seem to be few
teens for whom the decision to come out is not a major life disruption.
Parents may have a range of reactions, with negative reactions common,
but not a certainty in all families. Even when parents are apparently
supportive, they may have little patience for the long periods of
identity uncertainty and exploration of many adolescents, and may
cut off avenues for the heart-to-heart conversations which their lesbian
and gay children want. Some parents demonstrate what appears to be
an almost obligatory initial negative reaction based on religious
doctrine, only to become far more accepting later. Overall, the decision
to come out to parents often provokes a family crisis of some sort.
Once a gay or lesbian teen has come out, even supportive parents are
faced with a confusing array of choices about how to set appropriate
limits. Toward which same-sex friends might their child be attracted?
Are sleep-overs still okay? With whom will they allow their children
to associate? Are dating rules the same as with other siblings?
When counseling lesbian and gay adolescents, an awareness of the typical
stresses of homosexual identity formation is vital (Coleman & Remafedi,
1989; Gonsiorek, 1988; Slater, 1988). Without such awareness, behaviors
that are normal within the "coming out" context can be viewed inaccurately
as indicators of more serious problems or psychopathology. Conversely,
counselors unfamiliar with typical issues of the coming out process
may minimize or ignore the significance of behaviors or situations
which create genuine danger for the young person. It is critical that
the impact of adaptation processes to homosexual identity be differentiated
from other presenting issues.
Other Counseling Issues
For many adolescents, the timing of sexual identity uncertainty occurs
somewhat later in their school career. For example, progress through
Stage 3 (identity tolerance) and Stage 4 (identity acceptance) often
is forestalled until after leaving high school. College environments
and/or the financial independence that employment permits provide
an opportunity to more freely explore issues of sexual identity. While
in school, however, "adaptation" to sexual orientation uncertainty
may take more socially acceptable forms, such as academic or athletic
overachievement, perfectionism, or overinvolvement in extra-curricular
activities. As a reaction formation against unacceptable thoughts
and attractions, adolescent females may exaggerate their heterosexuality
and engage in promiscuous behavior, even becoming pregnant to establish
a heterosexual identity to others and to ward off internal fears of
a homosexual identity.
As a group, these adolescents comprise an invisible sexual minority,
often not disclosing their sexual orientation to others. They are
the silent teens who struggle in isolation and fear of discovery (to
self or others), yet survive using societally acceptable methods.
Their price is high, however, as the consequent emotional isolation
inhibits the timely and successful progression of adolescent developmental
tasks which are put on "hold" until a safer time. In this regard,
teens denied the opportunity to develop the social and sexual experiences
appropriate to their developmental stage, predictably become the adults
who later must experience this social and sexual adolescence, with
all its awkwardness, before moving on to adult mastery of social and
sexual situations.
Since a silent and invisible population of sexual minority students
is unidentifiable, providing service to them becomes difficult. School
counselors are in the best position to address this group, as they
have access to the entire student body. While it may not be possible
to provide direct service, indirect methods can create a more hospitalable
environment for teens questioning their sexual identity in the schools.
These efforts might include publishing articles about gay and lesbian
teens in the school newspaper, providing books on gay and lesbian
issues for the school library, having homosexual literature available
in the waiting area, inservicing teachers and administrators on gay
and lesbian youth issues, and developing policies which support teachers
in challenging homophobic remarks.
Such work begins the process of advocacy for these students. However,
these behaviors are not without risk for the school counselor, since
homophobic school boards and parents can apply pressure to prevent
such "encouragement of the gay lifestyle" from occurring in their
schools. It is our position that the needs of these at-risk adolescents
far outweigh the costs of advocating on their behalf.
If not the counselor, then who?
CONCLUSIONS
Lesbian and gay teenagers, or any adolescents whose sexual identity
is uncertain, face a challenging combination of barriers on their
journey toward formation of a positive identity. For many, this journey
may include an extended period in which sexual orientation is unclear.
Under ideal circumstances, parents, counselors, and other important
figures in the lives of these teenagers will not only tolerate, but
encourage the young person in their exploration of sexual identity
issues. Throughout this process, it is important to allow the teen
to "try" on labels, rather than adopt them. When appropriate to provide
adolescents with information about resources within the gay, lesbian,
and bisexual communities, it is crucial that the counselor screen
resources for safety and appropriateness. Token efforts to meet the
needs of gay, lesbian or bisexual youth by offering a single support
group or library book are insufficient. There is need for a variety
of resources, including written materials, waiting room posters, library
resources and, ideally, at least one identified "safe" school faculty
or staff member who is available for discussions and whose expertise
in this area is made known to students.
Because the majority of adolescents with sexual identity concerns
will remain hidden throughout their school careers, systems advocacy
on their behalf is critical. In this regard, mental health workers
focusing on adolescent populations as well as school counselors can
work in concert to develop and implement school policies which provide
safety from physical and verbal threats and abuse, and acknowledge
the existence and legitimacy of individuals with a homosexual or bisexual
orientation. Although such measures often provoke controversy, the
alternative is to perpetuate an environment which places lesbian,
gay, and bisexual youth (as well as those uncertain about their orientation)
at risk of mental health problems and school drop out.
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