Thirty year ago, the agenda for therapists working with homosexuals, stated or otherwise, was likely to be “conversion” to heterosexuality. Whether through confrontation, subtle persuasion, exploration of childhood trauma, or even electroshock, the goal was to reclaim the homosexual from the ranks of social misfits. Not surprisingly, gays and lesbians were, at best, reluctant consumers of the therapies of that era.

In 1969, the Stonewall riot, a spontaneous protest triggered by a police raid of a gay and lesbian bar in Greenwich Village, marked the beginning of the fight for gay and lesbian civil rights and the move out of the closet for millions in the United States. By 1973, the American Psychiatric Association had struck homosexuality from its Diagnostic and Statistical Manual of Psychiatric Disorders (DSM II), ending sanctioned prejudice by mental health professionals and finally conceding there was no more pathology in gays and lesbians than heterosexuals. But while homosexuality was depathologized, therapists were given no guidance as to how to think about or work with their gay and lesbian clients.

This is still largely the case. Within the field of family therapy, for example, there is little or no discussion of gay and lesbian treatment issues at conferences or in the mainstream literature. Those who do participate in gay/lesbian workshops or read or write about treatment issues are almost always homosexuals themselves. Few graduate programs include required reading on same-sex couples or discussion of homosexuality. Today, gay and lesbian issues continue to be generally ignored by most therapists.

The result is that many heterosexual therapists think that avoiding society’s classic fear and loathing of gays and lesbians is all they need to work effectively with this population. “Most family therapists have the correct politics in their heads,” says family therapist David Treadway, “but we don’t deal with our deeper prejudices and reactivity regarding lesbians and gays. The treatment of homosexuals today is similar to the therapy we did before the feminist critique got us to look at the disempowering messages therapy-as-usual was sending our female clients.”

Many gay and lesbian clients believe their straight therapists still harbor the assumption that it is less than normal or less preferable to be homosexual. “Some family therapists think that somewhere in the family system you can find the roots or cause of homosexuality, that it secretly has something to do with family dysfunction,” Says Marianne Walters, one of the founders of the Women’s Project in Family Therapy. “Family therapists haven’t yet considered what it means that our theory is based on a heterosexual model. I understand why gays and lesbians would only want to see gay and lesbian therapists.”

On the other hand, gays and lesbians are hungry for what family therapists can offer. “This population needs and craves a stronger connection with their families of origin, and they are striving to create meaningful family systems for themselves,” says Treadway. But when straight therapists do treat gays and lesbians, they often ignore or underestimate the experiential gulf that separates therapist and client. Without an understanding of the extent to which we all internalize the belief that homosexuality is a perversion, a character defect, or a moral flaw, even the best-intentioned therapist will echo the negative messages gay and lesbian clients have already been bombarded with, often making matters worse.

For years James had wrestled with questions about his own sexuality, but the summer of his junior year in college everything came to a head. He had spent his vacation dreaming obsessively about his college roommate, desperately missing him, counting the days until fall semester began. Then, a few weeks before the start of school, the roommate called to say he was taking a year off to be with his girlfriend in California.

“I was more depressed than I had ever been in my life,” says James. “I went to see a therapist, who at first seemed pretty cool. He said he didn’t care at all whether or not I was gay, but that maybe my feelings for Sam were all part of a fantasy I had gotten lost in. He told me not to write to Sam or see him for a while, ‘until you get over your confusion.’ He suggested I buy a copy of Playboy, and asked me to describe my idea of a sexy woman. I never went back to see him but it took another six months of depression before I finally came out to myself and found a gay therapist who could help me understand what was happening.”

James’ therapist probably thought he was helping a confused young man keep his options open But it is exactly this kind of approach that has convinced many gay and lesbian clients that straight therapists don’t understand their struggles and are secretly threatened by their sexuality. “What the therapist in this case did is dismiss James’ feelings as having no meaning,” says gay family therapist John Patten of the Ackerman Institute of Family Therapy. “When a client like James has a fantasy, the therapist’s job is to explore it, not treat it as if it were dangerous. The therapist frightened James away from his feelings, reinforcing the inner voice that was telling him there was something wrong with those feelings.”

The themes of shame, secrecy, and fear of disclosure are inevitably part of the freight most gay and lesbian clients bring to therapy. Straight therapists who are not familiar with this emotional constellation and how it changes through the coming-out process can give clients some very bad advice.

Vicky was a 38-year-old divorcee with two teenage children. After two years with a therapist whom she found extremely helpful in guiding her through her divorce, Vicky came out to herself. “But when I told my therapist I had realized I was a lesbian, her first response was that I shouldn’t burden my children by telling them,” recalls Vicky. She left therapy a year later, and soon after started dating a woman, who then moved in with her. “The kids accepted the arrangement at first, but after a while they caught on that there was something else going on, and started to act up,” says Vicky. “I wanted to come out to them, but I had my therapist’s voice in my head telling me it would be bad for them. For three years, my home was a war zone, until both kids decided to move in with their father. After they left, my lover and I were too tired from all the fighting and the resentment over losing the kids to save the relationship, and she moved out. I woke up one morning, alone, and close to suicide.”

No doubt the therapist in this case thought she was protecting Vicky and her children. “She was apparently concerned that if Vicky raised the issue of her sexuality to her adolescent children, it would be harmful to them,” says family therapist Claudia Bepko. “But it’s the secrecy itself that is most damaging to families in this situation. If Vicky was comfortable about her own choice, she could have supported her children while they grappled with understanding and accepting her lesbianism. Instead of helping Vicky prepare for the various reactions she might encounter coming out, the therapist amplified Vicky’s own fear that there was something destructive in her choice that needed to be hidden.”

Any discussion of the difficulties homosexuals and heterosexual experience when they try to bridge the chasm between them, whether in therapy or outside it, brings up the issue of homophobia. As with other words, like “sexism” and “racism,” that condemn once socially accepted behavior, “homophobia” can put us off, make us anxious to protect ourselves from perceived accusations of bigotry. But homophobia is not only a conscious attitude or set of beliefs. It is also a visceral experience that emotionally resonates to our core sense of ourselves.

Ignorance, insensitivity, stereotyped thinking, outright prejudice, discrimination, and a host of negative attitudes all can be loosely grouped under the umbrella of homophobia. At its most blatant, homophobia takes the form of outrage, that enables gay-bashers to feel justified in striking out against those they consider traitors to the natural order of human relationships. Most of us experience a quieter, more subtle type of homophobia when we encounter homosexuality—it is startling to have our unthinking assumptions about our sexual identities jostled. We may not go on the attack when we feel these uncomfortable stirrings, but despite our best intentions, our hostility, fear, and fumbling self-consciousness may spew out.

Because of what they represent for straight society, gays and lesbians are in the unenviable position of regularly setting off these anxious rumblings. To protect themselves, they learn to label these overt and covert expressions of disapproval and rejection as homophobia, putting the burden back where they feel it belongs. As a result, some straight therapists describe sessions with lesbian and gay clients as walks through a jungle filled with hidden patches of quicksand. “I wait for the axe to fall, for my lesbian and gay clients to accuse me of being homophobic,” says one straight therapist. “And the fact is, usually they’re right.”

Assumptions about homosexuality are often based on lack of information or outright false notions, and most people, including mental health professionals, aren’t sensitized to recognizing these errors. Therapists can clarify their own feelings and attitudes about homosexuality by visualizing a spectrum of attitudes, with most straight clinicians falling somewhere between the two extremes. At one end, a faulty assumption is that, whatever the presenting complaint, homosexuality is the fundamental problem. “I went to therapy after I had been out to myself and in most areas of my life for 15 years,” says one 55-year-old man. “We spent the first session arguing about whether homosexuality is biologically or socially based. Finally, I told him it didn’t really matter—I was gay, and that was a fact. I had come to therapy to deal with my anger toward my alcoholic father who was ill, close to dying. He asked me if I had come out to him and I said no, our relationship had never been that good, and there were so many other problems between us that I didn’t want to add another. The therapist told me that until I came out to my dad, I wouldn’t be able to have an equal relationship with him. I was frustrated—he was missing the point. It was like knowing I was gay was a clinical buoy the therapist could cling to, that somehow everything in my life was going to be about my sexuality.”

At the other extreme, a therapist might believe that homosexual preference makes absolutely no difference at all, so why make a big deal about it? “I was miserable because it was another Christmas and my family hadn’t invited my lover home with me for the holiday,” remembers 32-year-old Heidi, a graphic artist. “I had been out to them for a few years, and they were civil to Becky, but they never really acknowledged our relationship. Invitations to family events never included her. I felt angry, and I asked my therapist what to do. She seemed surprised, and said she thought I was used to the arrangement by now, and wondered why I was so upset. When I said I thought my parents were being homophobic, she asked me, ‘Don’t you think they might want to have just family for the holidays? After all, Christmas is traditionally a family-only holiday.’ When I told her that Becky was my family, she asked me why I was taking such a belligerent stance.”

When straight therapists are confronted with the conflictual feelings about homosexuality, they can either deny them or face them. “The first time I did work with a training program at a gay and lesbian community center, I work my heterosexuality on my sleeve and came across very macho,” says family therapist Michael Elkin. “The gay and lesbian therapists picked it up and accused me of not liking them, having contempt for them, not knowing about them. Of course, I got defensive, but my defensiveness revealed to me that something was going on. I discovered I had an enormous amount of discomfort with whatever homosexual feelings I, myself, might have. But extreme homophobic reactions lost leverage with me when I accepted that homosexuality was a potential in me.”

Family therapists, whose training typically deemphasizes countertransference issues, may be more comfortable finding quick solutions to problems than tracking-or even seeing-the dynamics of homophobia in the therapist-client relationship. “It can be frightening when the straight therapist begins to experience feelings of attraction to gay or lesbian clients,” says lesbian family therapist Cindy Myers, who conducts workshops helping therapists examine their own sexual attitudes. “Society dumps its anxiety about sexuality onto lesbians and gays.  I’ve spoken to many straight therapists who say they were all too ready to blame their gay or lesbian clients for the own discomfort in therapy or who automatically concluded those clients were being seductive.”

While the feelings may be unavoidable, the therapists must decide whether they will allow them to go underground or whether they will use their discomfort to help them do some serious thinking about their own sexuality. “I can’t imagine doing family therapy without having done some important thinking about my own family of origin,” says family therapist Frederick Brewster. “In the same way, I think we need to examine our own ideas about sexuality and our own stereotypes of homosexuality before we work with gays and lesbians. Which of our own issues are spilling over into the therapy room? How are we reacting emotionally to what the client is saying?”

David Scasta, editor of the Journal of Gay and Lesbian Psychotherapy, thinks that doing therapy with gays and lesbians is not for every clinician, but is a specialized field that requires a heightened level of self-awareness, and commitment to become educated about gay and lesbian issues. “All of us—gay and straight—absorb the abundance of homophobic messages out there. Gay and lesbian therapists, through their own coming-out processes, have usually been forced to confront their internalized fears and stereotypes. Straight therapists need to do the same kind of self-examination to make sure their homophobia doesn’t intrude into their clinical work.”

Once therapists have begun to examine their own fears, they are less likely to succumb to homophobia in sessions.

“When I feel anxious,” says Elkin, “I will tell the client that I am getting uncomfortable, since the client is probably feeling it too. After I tell them, I help them process it—we talk about what it means about our relationship, how they feel about it. Sometimes, I just own it to myself, and I try to understand what it was that made me feel threatened. My job, when I am doing therapy, is to notice the part of me that is withholding love and putting out judgment, and to keep processing it and getting help with it.”

One of the first agendas of therapy with homosexual clients can be acknowledging the differences between therapist and client, and recognizing the very likely possibility that suspicion and misunderstanding will occur. “When I start therapy with a lesbian couple, I tell them that, as a heterosexual man, I may sometimes be off-base in my attitudes and ways of thinking about them,” says Treadway. “I tell them that I need them to let me know if they pick that up from me, and I admit that I might need information to understand their internal experience.”

Further complicating therapy involving a straight therapist and homosexual clients is that the clients may be on their guards to perceived judgments or may test their straight therapists for latent homophobia. One straight therapist recalled a session in which a “a gay client told me about a comment his boss had made that the client considered homophobic. I asked him what he thought was homophobic about it. ‘I’m not paying you to educate you about homophobia,’ he snapped at me. I was taken aback, and had to explain that I wasn’t asking for my edification but was asking in the same way I might ask why he thought his mother’s forgetting his birthday every year was rejecting—it was to challenge him to describe what the experience meant to him.”

Straight therapists may be on probation while their homosexual clients try to gauge whether they are truly trustworthy. “I remember one gay couple I saw who would explicitly describe their sex life and it made me extremely uncomfortable,” says Elkin. “But I also wondered what was going on—why were they telling me this stuff? It was way more detail than heterosexual couples usually go into with me. I began suspecting they were testing me, so I told them I was having a reaction and asked why they needed to be that explicit. They owned up to the fact that they were testing me, which led to a great discussion of their discomfort about working with a heterosexual therapist.”

While therapists working with lesbian and gay clients need to stay attuned to their own subjective reactions, resolving the therapists’ homophobia should not become the goal of treatment. “If a client feels I have been homophobic, I will talk to them about what they felt when they perceived themselves as under attack, and what they felt it meant about our relationship, but I will keep it on what they heard rather than what I may or may not have said,” says Elkin. “I will do this whether I agree it was homophobic or not, because that isn’t the issue. That they feel attacked is the issue, and I have to assume the feeling excites their shame, resonates with some attacks they are making on themselves.”

“Use the process of self-examination to compensate for the way our culture handicaps us when it comes to understanding sexuality,” counsels Myers. “We have all—gay, lesbian, and straight—been taught to fear out different sexual feelings. By undertaking the task of examining our own attitudes about sexuality, we can really join with gay and lesbian clients, not just pretend we have and endure sweaty palms as we wait to be found out.”

The conventional wisdom in the therapy world has been that every couple—lesbian, gay, or straight—grapples with the same standard issues of communication and intimacy. But it is an oversimplification to say that the same techniques and theories applied to straight couples will fit lesbian and gay couples. “For a long time, I thought the same way many white people used to think-that they weren’t supposed to mention racial differences because it might mean they were racist,” says David Treadway. “When I first started working with lesbian couples, I thought, ‘Relationships are relationships.’ I tried not to notice that a couple was lesbian. It turned out not to be a very useful way of working. I was ignoring the fact that gays and lesbians live in a hostile world and rejecting society, and that having partners of the same gender creates unique relationship dynamic.”

Unfortunately, many therapists are unfamiliar with same-sex couples and know only stereotypes of rigid butch and femme roles, which were the primary way of same-sex relating in the days before Stonewall. One partner played the submissive “female” role, and the other the dominant “male” role. This was an attempt by gays and lesbians to mimic the straight society from whom they craved approval. The image of women and men in drag still exists in the minds of most straight people. Treadway remembers when he first worked with lesbian couples, he unconsciously assigned “male” and “female” labels to the partners based on how feminine or masculine they seemed. “It was hard to shift gears and realize they were both women. It was brand new for me, and I didn’t know how to think about their relationship in any other terms but male/female.” 

Therapists who move in too quickly to focus on communication problems in a same-sex couple are likely to miss the bigger picture. “The couple or family status is constantly being questioned and challenged by the mainstream society; internalized homophobia is an ongoing presence in both partners. Whether, when, and how to come out is a continuing question; and negotiating roles in a same-sex relationship is a persistent challenge,” say lesbian family therapists Julie Mencher and Suzanne Slater in their work-in-progress on the lesbian family life cycle.

The fact that same-sex couples have to balance stress in so many systems at once—their own families of origin, their relationship, the gay/lesbian community, their ethnic or religious communities, and mainstream society—makes their efforts at forming a family an impressive juggling act. And the complexity of a relationship between people with the same gender socialization can create further confusion and conflict, yet the problem may not be evident to the straight therapist.

Mark and Keith hit a crisis four years into their relationship when Mark decided to go back to work as a waiter. Keith who had been supporting them both on his physician’s salary while Mark kept house, was upset by Mark’s decision. But the more he tried to convince Mark to stay at home, the more determined Mark was to work, despite his lover’s protests.

They went to a gay therapist in a last effort to save their relationship. The therapist reframed the problem for the men. “He explained that when the couple consists of two men, both of whom have been socialized to be breadwinners and providers, there is a strong need for equality between the partners,” says Mark. “He said I may have been feeling less of a man because I was ‘kept.’ It finally sunk in for Keith why I was insisting on working eight hours a day and putting my paycheck toward household expenses even if I didn’t need to. I needed to feel equal to him. After that, Keith respected my decision and we got along better than ever.”

In his book Counseling Same-Sex Couples, gay family therapist Douglas Carl describes how men have been trained to be sexual predators whose conquests are cause for pride and status—while women are taught not to be sexual but domestic. “Now, instead of a predator coupling with someone who works to keep the home together emotionally, we have two predators trying to maintain a relationship,” writes Carl. “Now, instead of someone taught to be sexually aggressive coupling with a mate taught to be sexually more passive, we have two sexually passive women in the same relationship who may feel, for example, that there is intrinsically something wrong with sexual aggression or even with sexual instigation.”

Shared gender training creates other special problems for same-sex couples. For example, men are taught from youth not to show strong emotions, and jealous is regarded as unmasculine and shameful. Therapists need to be aware that the partners in a gay couple may really need more assurance from one another than do most heterosexual partners. “It goes beyond jealousy,” says John Patter. “There is little outside support to lend stability to the relationship other than what the couples creates for itself, so any excursion outside the couple boundary can seem threatening to a partner. There is also the reality that many, although not all, gay men lean primarily toward monogamy but believe that it is okay to stray from time to time as long as you don’t talk about it, and as long as you play it safe.”

Straight therapists often make the mistake of pathologizing patterns in same-sex couples that actually serve to protect the relationship. In lesbian couples, for example, enmeshment is often viewed as the primary difficulty. In contrast, Slater and Mencher view the higher level of fusion in lesbian relationships as a useful compensatory mechanism. “The entire culture is trying to pull a lesbian couple apart—telling them they’re not a couple at all, or saying homosexuality is sick and perverted, or it’s destroying their families,” says Slater. “And under the surface of the couple’s thoughts is their own homophobic whisper, “Lesbian relationships never last. This is doomed from the start.’ So couples respond to that pressure by pulling tightly together and blurring their distinctions—a creative and useful way to hold together under that strain.”

But fusion isn’t just a response to homophobia. “Lesbian partners will describe the level of involvement they have in one another’s lives, and their therapist will usually tell them they are too enmeshed,” says Mencher. “The literature that automatically calls fusion pathological is based on a male model of development that values distance over affiliation, and heterosexual models that view a large dose of difference and distance as normative. Lesbian relationships are the closest we can get to understanding how women relate outside the patriarchy, and what we are finding is that some fusion is a normative expression of what women want—they enjoy and are nourished by a great deal of closeness and interaction.”

One of Slater’s clients, Maria, was 26 when her parents confronted her about her relationship with her roommate, Sarah. Maria admitted that she and Sarah were lovers, and her mother told her she would have to choose between her family or Sarah. The thought of being cut off from her close, Italian-American family was agonizing, but she did not want to leave Sarah. At first, she agreed to see her family on any terms, which meant Sarah was not invited, and she could not talk about her lifestyle.

Maria and Sarah’s response to this pressure was to create their own close-knit family. They got a pet together, which became their child. They bought a house together, bought furniture together including a double bed. They imbued all their homemaking with ritual significance, each purchase or home improvement affirming their long-term commitment to one another. This intense closeness gave Maria the ability to meet her family’s ultimatum from a position of strength. She eventually insisted that whenever she was invited, Sarah had to be welcome as well, and that the family acknowledge her relationship. Surprised by her insistence, and impressed by her commitment to Sarah, the family agreed.

“Fusion allowed Maria to shift the power dynamic,” says Slater. “This isn’t to say fusion was not also problematic, but it gave Maria the support she needed to take a stand with her family.” Slater also working on helping lesbian couples face their differences and deal with conflict. Frequently, she begins by telling partners to stop wearing each other’s clothes. “For weeks, one couple came in wearing identical shoes,” recalls Slater. “I mentioned it one week, and the next week they came in and pointed out first thing that they were wearing different shoes. But they were horrified to discover they had on identical socks. I told them sometimes it could feel great to have similar socks, and some days you might want your own. It opened them up to considering how they hadn’t tolerated much difference in their relationship, and how they could enjoy and borrow from each other’s uniqueness.”

We had yet to fit the image of two gay dads or two lesbian moms going to a PTA meeting at their child’s school among our pictures of accepted forms of family life. For many gay and lesbian clients, this lack of acceptance is at the core of their problem. They come to family therapy in search of what they cannot give themselves; affirmation that, yes, they are a family—that being two people, with or without children, who love each other and are committed to being together, constitutes family.

Traditionally, families have looked to rituals to provide them with their sense of connection to each other and a feeling of their place in the world. Increasingly, gays and lesbians, refusing to remain outcasts on the margins of society, are celebrating their connections to lovers, friends, family, and community.

The friends and brothers of one lesbian, whose lover had died in a car crash, had a ceremony presenting the grieving woman with a black shawl that represented her morning and acknowledge her widowhood. They gathered together a year later to mark the end of the formal period of mourning and presented her with a many-colored shawl that represented healing. One gay couple who adopted a baby invited their family and friends to a family forming ritual. The couple ceremoniously presented their baby to the assembled guests, announcing her name, the names of her new grandparents, aunts, uncles and parents, and officially proclaiming themselves a family. The child was passed from person to person, and each one pronounced her full name. Then individuals read poems, passages, and prayers of love and support for the new family. 

Twenty years ago, the prospect of gay men raising children, lesbians bearing children by alternative insemination and being open about their arrangement, and same-sex couples fighting for the same benefits as married people was literally unimaginable. Back then, the idea of same-sex couples having wedding and inviting their extended families could only have been a comic’s homophobic fantasy.

But times are changing.

It is a perfect, blue-skyed Arizona day as Miguel and Tom prepare to formally join their lives together. As the flute and piano begin a gentle Brahms piece, the two men walk between teary-eyed friends, coworkers who don’t know what to make of it, and Mexican and Irish relatives from both sides who watch the proceedings with mixed emotions. Miguel’s father hasn’t come. Neither has Tom’s sister-in-law or nephew.

The ceremony is brief. They address each other, describing how they discovered their love for one another eight years ago. Tom looks over the faces of his family—cousins, aunts, uncles, even a great uncle. He has bene to their weddings, to ceremonies for the births of their children and parties marking their anniversaries, and never expected them to share in his life the same way. He is amazed to see how open their faces are now, how much love for him they have, and he remembers how he almost didn’t invite them, assuming they wouldn’t want to come.

Miguel looks over at his mother and their eyes meet. He sees in his mother’s face the love and acceptance he thought he had forsaken when he came out so many years ago. She has stood by him despite his father’s refusal to come today. That means everything.

After the ceremony, there are toasts. Tom’s mother is standing with her arm around Miguel, and Miguel’s mother is pouring champagne for the guests. It is Miguel’s mother who taps her glass and gets everyone’s attention.

“When I married Miguel’s father, I remember wishing that my children would be as happy on their wedding days as I was on mine. Today, that wish has come true. It hasn’t been easy for Miguel and Tom. We’ve given them a hard time,” there is some laughter, “and they’ve had to overcome more than most people to get to this day. But today they’ve made a promise to each other to continue to grow in their love, to be a blessing to each other and to us. They have made us proud today. I am lucky to have this gay son.”

This article originally appeared in the January/February 1991 issue of Psychotherapy Networker.

Laura M. Markowitz thanks Mary Kay LeFevour, Ellen Elgart, Rose Mary Evans, and Eugene Morris for their help on this article.

Note: Parents and Friends of Lesbians and Gays (PFLAG) is a national organization that provides information and fights discrimination against homosexuals and offers support to the families of gays and lesbians. 

Laura Markowitz

Laura Markowitz is a journalist, editor and multimedia producer in Tucson, Arizona, and winner of a National Magazine Award for writing and coeditor of The Evolving Therapist: Ten Years of the Family Therapy Networker.