With growing frequency, social workers find themselves making clinical assessments of families whose members' affectional or sexual orientation cannot be ignored. Social workers, therefore, would be well advised to develop a professional approach that includes the treatment of lesbian and gay clients within the context of the family. Family therapy is such an approach; applied to the treatment of homosexuals, it focuses on the family systems and the family dynamics of this special client group.
The social worker as family therapist recognizes that although many lesbians and gays are estranged from their families of origin, roles acquired in these families reemerge in other social relationships, and that those roles need examining. Many adult homosexuals marry and produce offspring, thereby creating families of their own. The family therapist must investigate these newly created family systems. A large number of family households as well include homosexual adolescents who, as minors, are under the care of their parents.* Here, the family therapist must explore the dynamics between parents and their children. Furthermore, it is safe. to assume that social workers have homosexual clients and are not aware of this fact, perhaps because such clients are married and have children, thus providing the appearance of heterosexuality. If the family therapist is to be able to decipher family secrets and alliances, thereby helping client families receive the services they seek, it is critical that the sexual orientation of family members be addressed and that family work be advanced with homosexual clients
Despite the critical nature of such work, to date there has been a general lack of training for social workers who provide clinical family services for this client population. Schools of social work typically teach little or nothing about family therapy with homosexuals or about their families and support systems. Moreover, there is very little in the professional literature addressing either the treatment of lesbian and gay clients through family therapy or the attitudes toward homosexuality held by therapists who work with these clients. Hall's (1978) work stands out as a pioneering effort. She argued for practitioners who work with lesbian families to examine their own attitudes toward members of this minority group prior to attempting intervention in the family systems of their clients.
Clearly, family therapy with homosexuals and their families, a new phenomenon in social work practice, warrants exploration. To this end, the author explores issues and presents practice methods based on his observations as a clinical social worker in a suburban community's mental ____________________________________________________________________________
*See Alan P. Bell, Martin S. Weinberg, and Susan Kiefer-Hammersmith. Sexual Preference: Its
Development in Men and Women (Bloomington. Ind.: Indiana University Press. 1981); and A. C.
Kinsey, W. B. Pomeroy, and C. E. Martin, Sexual Behavior in the Human Male (Philadelphia: W.
B. Saunders, 1948).
health center and as a private practitioner in a large city. By expanding the traditional meaning of "family" to include the important others in the lives of lesbian and gay clients, the author hopes this article will provide the beginnings of an ongoing discussion of the practice of family treatment with the homosexual client
Such a beginning may also help to convince social work educators and supervisors of the need for training in this area, from a nonhomophobic perspective. Here, homophobia is defined as fear of homosexuality and is commonly associated with prejudice toward and discrimination against homosexuals (Weinberg, 1973).
Family work with homosexual clients poses unique problems not found with other client groups. The most significant is self-disclosure, "coming out," to the important others in the client's life. The client may be hesitant for or not wish the family to know about his or her sexual orientation. This hesitation must be respected, but also explored. The therapist may choose to investigate with the client whether the decision not to disclose his or her sexual orientation is based on a perceived need to save "unnecessary pain" or on persistent self-hatred. For the family therapist, an exploration of this question can be a diagnostic probe into how the client views the workings of his or her family.
One approach might be to initiate a discussion of the motives and timing for such a disclosure. Having worked with angry clients during the initial stage of treatment, often the author has observed their coming out to parents, spouse, or children as a vehicle for hostile acting out. When such behavior seems likely to occur, ordinarily, the client is counseled to use restraint until this information can be used as a bridge to increase family intimacy. If such disclosure serves as a way to improve communication, rather than as a weapon, it is advisable. Otherwise, the client's sexual orientation is better left undisclosed, at least on a short-term basis.
Very often the self-identified homosexual client blames his or her sexual orientation as being the "cause" of a current dilemma. In such a case, the nonhomophobic, skilled family therapist points out this dynamic for what it is: the client's internalized homophobia; it is merely a defense and must be labeled as such by the therapist. Often a partial projection is in operation in such cases. What is usually fostering the client's feelings of discomfort is society's negative response to the homosexual parent, child, or individual. Thus, the homosexual adolescent or the divorced homosexual becomes the family's symptom bearer in ways very similar to those of a person with a psychiatric or emotional disability. Instead of looking clearly at all the multiple stresses currently affecting their family system and involving themselves in completing the required tasks of restructuring, homosexual clients often allow their homosexuality to assume all the responsibility for family homeostasis.
Some people marry and have children long before they discover or accept their homosexuality. The emotional and psychological strain on the entire family system that is created by the necessity of a homosexual parent having to decide how "out" to be because of the fear of losing his or her children through court decisions cannot be underestimated. Decisions such as whether to live with one's lover, whether to tell the children about one's sexual orientation, whether to fight to retain custody or win joint custody, and whether to fight for alimony or child support are some of the issues that homosexual parents face, and with which family therapists must be familiar.
These issues must be seriously considered because it may not be in the best interest of a lesbian or gay client to come out to his or her spouse and family. The courts routinely rule, solely on the grounds of sex preference, that natural parents are unfit to have partial custody or even
unsupervised visitation rights. (In 1980, in Kentucky, a judge cited an article published in Social
Work in support of his decision to deny custody to a lesbian mother following her divorce.)*
*S. vs S., Ky. App. 608 Social Work. 2d, 1964.
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Therefore, the family therapist must be aware of the need for caution about self-disclosure if there is any likelihood of a custody battle for the children, and the homosexual parent wishes to have custody or visitation rights. If such a battle appears probable, the client must be helped to see that his or her long-range need for self-protection must come before the immediate need for self-disclosure, which commonly accompanies the euphoria associated with accepting one's sexual orientation.
When working with homosexuals who are parents and, as such, members of a minority group, the social worker must be prepared to have his or her own values and assumptions about sex roles and stereotypes challenged. There are an increasing number of gay fathers who are seeking, at a minimum, joint custody of their children. Correspondingly, there are lesbian mothers who choose to relinquish rights of custody and visitation after coming out and ending marriages. In the author's practice, for example, a lesbian client spent seven years working through feelings of guilt, anger, and depression, as well as relief, resulting from her voluntarily relinquishing custody and all visitation access to her two daughters.
A therapist would be doing the client a disservice not to ready him or her for possible rejection by loved ones. In the case of homosexual parents, the possibility of rejection by their children increases with the age of the offspring. The younger the children, the more accepting they are about mom or dad's "being different." A useful analogy is to a child of interracial parentage, who learns early in life the price one pays for being different, for being a person of color in a racist society. This child also grows rich in the rewards of being the offspring of people from two different cultures. The ugly reality of racism, that some people loathe one simply because of who one's parents are and who they have dared to love, becomes a fact of life.
The child of a homosexual parent, just as the child of interracial parents, can learn at an early age to be more tolerant about difference and can grow stronger as a result of being different (Goodman, 1980). The child may be forced to contend with harassment from other children, particularly if residing with a custodial parent and that parent's same-sex lover. For instance, other children may taunt the child with, "Your dad's a 'fag'!" or "Your mom's a 'dyke'!" Despite such experiences, the child who grows up weathering the abuse of other children and who is secure in being loved will likely emerge as a healthy and resilient adult (Lewis, 1980).
Lesbian and gay parents often seek counseling for help in telling their children that they are homosexual. Family work in such cases usually focuses on the parents' ability to communicate clearly their reasons for agreeing to or initiating the dissolution of their marriage if, in fact, either decision has been made. Both parents and children usually require help in understanding one another's reactions and in expressing their love directly. Sometimes, behaving in typically preadolescent or adolescent ways, the children attempt to make use of this newly disclosed information by either acting out or attempting to manipulate in some way. For instance, the author's work includes that with families in which the children focus on the parents' homosexuality in an attempt to divert attention from behavioral problems that predate their parents' coming out. In such instances, the skilled family therapist helps the family to view the behavior as manipulative and to separate the content of the parents' sexuality from the real issues to be resolved.
The case that follows highlights a parent's feelings about coming out to his children, the children's response, and the role of the family therapist.
A gay father in his mid 50s, who had been estranged from his two adult daughters for 15 years, sought professional help to facilitate a family reconciliation following the death of his ex-wife. Treatment was very brief. Sessions focused on having current communications clear up misconceptions the three people had been holding about one another for years. The father's guilt about his sexual orientation had prevented him from ever speaking to his daughters directly about his reasons for having left the family home. These family sessions were the first time he had the opportunity to ventilate his feelings of sadness, loss, and guilt. For his daughters, the sessions provided a safe arena to talk about their feelings of abandonment by him, ensuing financial difficulties, and resulting rage toward and emotional distance from their father.
In this case, the father used his sexual orientation as scapegoat. His guilt about being gay prevented him from dealing with himself or his children and their feelings about his having left the marriage and them.
For therapy with reconstituted families, an important factor is to include members who comprise the entire family system at certain therapy sessions. The live-in lover of the custodial parent needs to be included as well as the noncustodial parent and his or her new partner.
The family therapist must prepare the client for a number of possible reactions from his or her family to the disclosure of sexual orientation. For instance, on being told of his homosexuality, the family members of a Jewish client sat shiva for him and have not seen or spoken to him since. (Shiva is the traditional week of mourning for Jews following the burial of a family member.) Though an extreme response, this example is, unfortunately, not singular.
Another task for the social worker who is helping a client decide when to come out to his or her family is a thorough exploration of the client's expectations of the parents' response in particular. The client may be in an emotionally needy time, for instance, following the breakup of a long-term love relationship, and he or she may hope that the disclosure will bring about nurturing from the parents. The client may need help to see this as a highly improbable outcome of self-disclosure.
A common case in the author's clinical experience is that of an adolescent who already self-identifies as gay or lesbian. This young person may have labeled him or herself this way despite never having actually engaged in sexual activity with a same sex partner. The fact that the adolescent considers himself gay or herself lesbian may be discovered by the parents by reading a letter or discovering a gay or lesbian book in the child's room. Overwrought by the discovery, the parents often will seek help for their child. Ordinarily, what they mean by "help" is for the therapist to ''fix'' their child by making him or her "straight:' or heterosexual.
At the outset, this situation is usually one of crisis intervention. Treatment can be short term, geared to assuaging the parents' feelings of responsibility for and guilt about the sexual orientation of their child. Bibliotherapy plays an important part in helping parents learn that being gay or lesbian is not the worst thing that could have happened to their child. Books, such as A Family Matter: A Parent's Guide to Homosexuality and Now That You Know: What Every Parent Should Know About Homosexuality, help the parents adjust to this disruption in their expectations of their offspring (Silverstein, 1978; Fairchild & Hayward, 1979). Referring parents of lesbians and gays to the self-help group Parents of Gays is often beneficial for parents who need peer support in working through their shock, anger, or denial.
Working with the adolescent client who is a self-identified homosexual almost always involves the therapist's assumption of the parental role, on a temporary basis. Often the parents themselves are so needy for emotional support that they are frequently unable to parent their homosexual offspring properly, at least initially. For many parents, therefore, the time immediately following the confirmation that their child is homosexual is when they require the greatest amount of nurturance and support from both their child and the therapist.
It is generally accepted by family theorists that behavioral dynamics and roles acquired in families of origin reemerge throughout people's lives, and that these patterns reemerge especially in families of creation (Gurman & Knisken, 1981). This process is no less true for lesbians and gays, or even for those instances in which homosexuals do not form traditional family units. A pervasive aspect of the lesbian and gay communities, and one that has been overlooked in the professional literature, is how chosen friendship networks and support systems become, in effect, new families of creation.
Indeed, when working individually with lesbian and gay clients, the author finds it helpful to complete genograms and sociograms. A genogram, on the one hand, is a history of the client's social network; it includes the client's current as well as past networks of lovers and friendships. A sociogram, on the other hand, is actually a diagram or map of where the individual places him, or herself in relation to all the interlocking systems within which he or she functions. Included in this diagram would be the client's affiliation with professional, social, familial, religious, and political organizations and his or her sexual liaisons. Used in addition to the traditional genogram, a sociogram is one way of both gathering the necessary history and charting a dynamic formulation.
Charting a sociogram helps illustrate many of the presenting issues that cause the client difficulty. At the same time, it clarifies for the therapist data that originally were reported in inconsistent or contradictory ways by the client. Furthermore, when reviewed with the client, the diagrams and maps help generate therapeutic discussion in which the client compares current positions in the various systems with positions he or she would like to hold, and investigates the means by which these dynamics have changed over the years. The technique provides insight oriented psychotherapy as well, by enabling the client to evaluate the roles important others currently play in his or her life and to recognize the ways in which these roles are similar to and patterned after those in the family of origin.
For clients who are self-identified as lesbian or gay and are severely depressed, suicidal, or undergoing detoxification from drugs or alcohol, the author finds treatment planning with members of the existing friendship network to be an effective treatment strategy. At times, merely having the client's existing social resources mobilized has a positive therapeutic effect in the recovery from psychiatric disability.
When members of a family of origin or family of creation (friendship network) are brought into a session "family sculpting" proves to be a valuable tool. Family sculpting is the physical positioning of the members of the client's family (of origin or creation) in ways that show the client's perceptions of the emotional ties between each member. The technique helps family members to clarify their perceptions of the dynamics that are present in the various family subsystems. This process has been effective in helping everyone, the client and the client's friends or family members, to find alternative ways of dealing with their problems.
Recent research suggests that in an enmeshed family system the addict or alcoholic is often the primary system bearer for family homeostasis (Stanton, 1982). Whereas traditional outpatient, drug free insight-oriented psychotherapy has not proved successful in rehabilitating addicts or alcoholics, family sculpting is an especially useful tool for working with such chemically dependent individuals. When members of the primary family system or friendship system of a substance abusing client are included in treatment, they become actively engaged in changing the patterns that perpetuate the drug-abusing behavior. Through their active participation, the client's self-destructive behavior should cease (Steinglass, 1979; Kaufman, 1979).
The following case illustrates the application of theories and techniques of family therapy in the author's work with a lesbian, identified as a substance abuser
Susan is a 24-year-old lesbian from a middle-class suburban family, and Ruth is her 40-year-old lover of three years. Ruth initiated therapy, seeking help for her "friend's" problem of taking nonprescribed codeine. Ruth prompted Susan to seek help for her drug problem by threatening to end their relationship if she did not begin treatment.
During the course of treatment they were seen exclusively as a couple. The drug taking seemed to be a symptom of Susan's unexpressed needs to be taken care of. Therapy is teaching Susan how to ask directly for what she needs and wants from Ruth, and to do so in ways that are not self-destructive.
The application of family therapy to lesbian and gay clients is limited only by the skill and creativity of the therapist. It is a method of psychotherapy for people who identify themselves as homosexual that will certainly grow in importance as lesbians and gays build more support systems that function as families. Family therapy will also prove important when social workers learn to recognize the changing definitions of "family" in contemporary America
By such recognition, workers can provide a great deal of support, guidance, and good clinical work to the families of lesbians and gays. This support may be both emotional and practical in nature. In order to do this work effectively, however, social workers must first recognize their own homophobia and then seek to work through possible prejudice toward homosexuals, as well as preexisting heterosexual bias.
Fairchild, B. & Hayward, N. (1979). Now That You Know: What Every Parent Should Know About Homosexuality. New York: Harcourt Brace Jovanovich.
Goodman, B. (1980). Some Mothers Are Lesbians," in E. Norman &A. Mancuso (Eds.), Women's Issues and Social Work Practice Itasca, Ill. F. E. Peacock Publishers.
Gurman, A.& Kniskern, D. Handbook of Family Therapy. New York: Brunner/Mazel, 1981.
Hall, M. (September 1978). Lesbian Families: Cultural and Clinical Issues," Social Work, pp. 380-385."
Kaufman, E. (1979). The Application of the Basic Principles of Family Therapy to the treatment of Drug and Alcohol Abusers, in E. Kaufman & P. Kaufmann, (Eds.) Family Therapy of Drug and Alcohol Abusers. New York: Halsted Press, pp. 255-272.
Lewis, G. (1980, May) "Children of Lesbians: Their pont of view. Social Work, 25, pp.198-203.
Silverstein, C. (1978). A Family Matter: A Parent's Guide to Homosexuality (New York: McGraw-Hill Book Co.
Stanton, D. (1982). Family Therapy of Drug Abuse and Addiction. New York: Guilford Press.
Steinglass, P. (1979). Family Therapy with Alcoholics: A Review. In E. Kaufman & P. Kaufman (Eds.) Family Therapy of Drug and Alcohol Abusers. New York: Halsted Press, pp. 147-186.
Weinberg, G. (1973). Society and the Healthy Homosexual. New York: Doubleday & Co.
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