Social Work Practice with the LGBTQ Community The

Social Work Practice with the LGBTQ Community: The Intersection of History, Health, Mental Health and Policy Factors Chapter 5: The Coming Out Process AUTHORS: MARK SMITH, PHD, LCSW MICHAEL P. DENTATO, PHD, MSW TYLER M. ARGÜELLO, PHD, DCSW, LCSW CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 1

Introduction This presentation provides highlights from Chapter 5, regarding the coming out process and experiences of LGBTQ individuals. It provides an overview of: ◦ Coming out during adolescent and young adult years, mid‐life, and older adulthood. ◦ Similarities and differences between experiences of gay men, lesbians, bisexuals, and transgender individuals are explored as well as the experiences of LGBTQ individuals from various environmental contexts: rural versus urban settings; racial, ethnic, and cultural identities; and the opportunities and constraints posed by close family relationships. ◦ Well‐established models that provide structural, stage‐based descriptions of the coming out process are reviewed as well as some of the exciting ways contemporary LGBT identities are being mediated by online and social media access. ◦ Case scenarios with questions for consideration. ◦ Pertinent national resources with web links. ◦ Listing of all references CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 2

What is “Coming Out”? § Individuals who experience same‐sex attraction or gender non‐ conforming self‐identities are expected to “come out of the closet” and declare this status publically. § The act of coming out enables individuals to live more truthfully and openly, leads to greater happiness, and ameliorates many potential physical and mental health concerns (Cox, Dewaele, van Houtte, & Vincke, 2011; D’Augelli & Grossman, 2001; Herek, 1988; Meyer, 2003; Proctor & Groze, 1994; Remafedi, 1987). § Coming out constitutes a primary event differentiating LGBTQ individuals from heterosexual or cisgender individuals, as it is unnecessary to “come out” as straight or gender‐conforming if one conforms to or has membership with dominant social norms. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 3

What is “Coming Out”? § LGBTQ individuals must weigh the inherent advantages of disclosing core information about themselves against the significant risks of public exposure and possible discrimination, rejection, or physical assault (D'Augelli, Hershberger, & Pilkington, 1998; Herek, 1988). § Today the strategies and social negotiations involved in the coming out process, for many individuals, has replaced the secret counter‐cultural aspect of identities of previous years and are the new central point of identity construction for sexual and gender minority lives (Gray, 2009; Mc. Kenna & Bargh, 1998; Pascoe, 2011). CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 4

Identities & Intersectionality § The process of constructing and establishing identities is understood to be an interactive, relational, and ongoing dynamic that involves engaging in a variety of narrative and performative actions (Butler, 2015; Goffman, 1959). § Identities, or self‐depictions, are not fixed, essential, or inevitable but are fluid constructions that help one navigate social spaces and organize personal experiences (Somers, 1994). § The process can become even more complex and demanding for those LGBTQ individuals who also are racial/ethnic minorities, multiethnic, and/or from unique cultural or religious backgrounds – especially those that are powerfully heterocentric, homophobic, condemning, or non‐ accepting. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 5

Adolescents § The degree to which a young person is able to accept or embrace parts of the self that are distinctly different from others is predicated on the belief that he or she will ultimately be accepted and loved despite those differences (Malyon, 1981). § If the young person has the perception that an important but divergent feature of his or her inner world will be vigorously rejected, “exploration of possible identities is thwarted by [anticipated] devaluation” (Jackson & Sullivan, 1994, p. 97). §When there is an intense sense of aversion towards one’s perception of self, the adolescent’s struggle with identity can become a retreat into “valiant but doomed attempts toward greater conventionality and social conformity” (Coleman, 1985, p. 33). §For LGBT youth, the dread of rejection of crucial and undeniable core aspects of their identity – sexual and gender identities – often results in a variety of desperate coping or hiding strategies (Martin, 1982). CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 6

Adolescents § Malyon (1981) formulated a series of three “ego defensive” strategies or stages adolescents are likely to employ when dealing with the unwelcome realization that they may be LGBT. §The three strategies include: (a) repression or denial; (b) suppression; and (c) acceptance and disclosure. §While these strategies or stages were intended to describe adolescent coming out processes, which is when most LGBT individuals make public declarations of sexual orientation and gender identity (Cox, Dewaele, van Houtte, & Vincke, 2011), the patterns described are also representative in the coming out struggles encountered at any age. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 7

Models - Troiden § Troiden (1979, 1989) used the metaphor of “sexual scripts” to explain how sexual identity development occurs and how they impact the coming out process. § These “sexual scripts” inform the individual about what is desired or perhaps not so desired in terms of sexual partners (the who), what is and is not proper sexual behavior (the what), what are permissible and non‐permissible settings (the where), what are acceptable and unacceptable motives for having sex (the why), and sanctioned and discredible sexual techniques (the how). § Troiden proposed a four‐stage model for homosexual identity acquisition: (a) sensitization, (b) identity confusion, (c) identity assumption, and (d) commitment. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 8

Models - Cass § Cass emphasized that gay or lesbian sexual identity and coming out is a linear, step‐wise process, and at the same time, the result of an accumulation of small tacit choices (see Nuehring & Fein, 1978) made across an extended time period. §Cass (1979) initially identified a six‐stage model for coming out for lesbians and gay men: (a) identity confusion, (b) identity comparison, (c) identity tolerance, (d) identity acceptance, (e) identity pride, and (f) identity synthesis. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 9

Lesbian Coming Out Models § Chapman and Brannock (1987) proposed a five‐stage model of lesbian coming out and identity development, which subsequent theorists have consistently built upon including: § (1) Same Sex Orientation, during which there is an awareness of being different from peers due to as yet unnamed attractions and a “special connection” felt with other women; § (2) Incongruence, during which there is the first undeniable recognition that feelings toward other women are sexual, while coupled with a sense of confusion regarding the lack of desire when faced with expectations to date boys/men; § (3) Self Questioning/Exploration, during which one begins to think, “I might be a lesbian” while acting on strong physical/sexual attractions with other women; § 4) Self Identification, during which there is acknowledgement that, “I am a lesbian, ” and the individual feels okay about it; and § 5) Choice of Lifestyle, during which there is a conscious decision to seek women as long‐term love/sexual mates, accompanied with a sense of belonging to the lesbian community. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 10

Lesbian Coming Out Models § Mc. Carn and Fassinger (1996) proposed a four‐stage model arising from an extended study of lesbian women that incorporated both individual awareness and group awareness. § The first stage Awareness underscores the coming out process to one’s self, and it involves the individual awareness of feeling or being different; § The second stage, Exploration, involves awareness and exploration of strong erotic feelings for other women or, usually, a particular woman; § The third stage, Deepening/Commitment, involves a personal commitment to increase self‐knowledge and fulfillment as well as to begin coming out to others and make concrete choices about sexuality; § Finally, stage four involves Internalization/Synthesis of love for women into one’s overall identity. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 11

Transgender Coming Out § As with coming out processes associated with sexual orientation, the first stage for transgender individuals is to come out to self. §This means acknowledging one’s own gender identity, recognizing that one is unlike the majority of others, and deciding how and to whom to express this difference. §Similar to coming out as lesbian, gay, or bisexual, deciding to disclose to others involves a series of decisions. § First one needs to educate oneself about being transgender, what it means, what it involves, and especially what potential dangers may be involved in disclosing. § Also, coming out as transgender may be similar to coming out as LGB in that it is crucial to anticipate what it will mean to specific and important relationships. § However, as a cautionary note, practitioners should not assume that coming out experiences are always similar when working with sexual minorities when compared to gender minorities. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 12

Transgender Coming Out § Awareness of discrepancy between one’s felt gender and one’s birth identified gender occurs quite young, perhaps as early as two or three years old (Brill & Pepper, 2008; Istar‐Lev, 2004). § While early years can be difficult for children who do not conform to socially sanctioned gender representations, the emergence of puberty and the beginning of the adolescent stage are when the most acute sense of gender dysphoria is often experienced. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 13

Transgender Coming Out – The Lev Model § Arlene Istar Lev (2004) proposes a six‐stage model for the process of transgender identification. §The model specifically tends to transgender individuals, their families, and clinicians. §Lev’s model simultaneously describes the identity development milestones, including importantly the process of coming out, of individuals as well as the responsibilities of a clinician to best assist their clients in coming out and into their identity. §Attention is given to the individual’s experiences. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 14

Transgender Coming Out – The Lev Model The six stages of the Lev Model include: § Awareness, is the coming out to one’s self for many individuals, and when gender non‐conforming individuals are often in significant distress about the discrepancy between who they feel themselves to be and who society says they are. § Seeking Information/Reaching Out, gender‐variant individuals seek education and support about the meaning of transgender identities and experiences, what the implications might be for them, and how others have managed various transition processes. § Disclosure to Significant Others or coming out to significant others (e. g. , partners, family, friends, coworkers). CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 15

Transgender Coming Out – The Lev Model § Exploration of Personal Identity & Self Labeling; here, transgender individuals explore and construct for themselves various trans* identities. § Exploration of Transition Issues and Possible Body Modification. In concurrence with identity wishes and desires articulated in the previous stage, individuals begin to explore options of body modification and transition for more consonant identity expression and presentation. § Integration, Acceptance, and Post Transition, in which the gender‐variant individual has successfully integrated a transgender identity, that is, their felt and lived experiences involve a full and sustained coming out across all contexts in their lives. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 16

Rural Settings § For individuals living in small rural communities that value close connections and conservative values, the discovery and acknowledgment of same‐sex desires or gender non‐conforming realities may prompt individuals to delay or completely avoid coming out. §This may be partly due to lack of access to the availability of supports found in more vibrant LGBTQ communities and amenities found in urban settings. §In the same regard, other occupational, religious, or family/cultural ties may be considered more important to publically affirm than personal declarations of sexual orientation or gender identity. §Rurally located individuals with same‐sex desires and behaviors or gender‐ variant orientations may simply decline to self‐identify because they feel media driven portrayals of urban gay, lesbian, bisexual, or transgender cultures simply do not represent them and their lived realities (D’Augelli & Preston, 2002; Gray, 2009) CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 17

Competing Identities § For many LGBTQ individuals, managing multiple identities based on sexuality, race/ethnicity, religion and other intersecting factors may significantly increase the difficulty of typical tasks associated with identity development and coming out processes. § Wallace, et al. (2002) found that among LGBTQ people of color, the primacy of sexual identities remained secondary to other identities and roles: racial/ethnic identities are prioritized over sexual identity in response to the many psychosocial and environmental barriers associated with race, ethnicity, and socioeconomic status. § Negotiating coming out as LGBTQ while also identifying as religiously observant has its own unique struggles. The virulent anti‐gay and transphobic rhetoric of most religious doctrine is among the most damaging and condemning of all social messages an LGBTQ person encounters (Mahaffy, 1996). CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 18

Online & Social Media § Coming out in in the digital era provides immensely expanded formats for exploring and constructing non‐heteronormative and gender‐variant identities (Bond, Hefner, & Drogos, 2009; Craig & Mc. Inroy, 2014; Gray, 2009; Hillier, & Harrison, 2007; Pascoe, 2011). § An additional factor when considering internet mediated identity processes is the ready access not only to pornography but to the hazardous landscape of online dating and sex sites. §Concerns about the deleterious effect such exposure might have for young people just beginning to develop their sexual identities has only just begun to have convincing evidence with confirmation provided by new neuro‐imaging ability (Love, Laier, Brand, Hatch, & Hajela, 2015). CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 19

Online & Social Media § While dangers of privacy and sharing personal information online persist, the advantages of being able to connect with others and share identity narratives minimizes the isolation and loneliness LGBTQ individuals living in rural and/or socially restrictive settings experience (Blais, Craig, Pepler, & Connolly, 2008). § Disclosing sexual orientations and gender variant identities online provides an opportunity to integrate coming out narratives without the very real risks that doing so in real life might have. § For most young LGBTQ individuals today, the first disclosures of suspected sexual orientation or gender‐variance take place in conversations with “trusted friends” online (Craig & Mc. Inroy, 2014; Egan, 2000; Hillier & Harrison, 2007). CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 20

Mid-Life Coming Out Factors § Some of the distinguishing features of coming out in mid‐life may involve an extra focus on coming to grips with losses that may have resulted from a lifetime of concessions and compromises made in the effort to pass as heterosexual or as gender‐conforming. § The perilous negotiations of coming out amidst the contexts of long‐ standing primary relationships, which may include marital partners and children, typically adds additional stressors to the process. § Many individuals who decide to come out in mid or later life must contend with a sense of having lived a lie – having lied about themselves to others they care about, as well as to themselves. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 21

Mid-Life Coming Out Factors § Some LGBTQ adults who come out later in mid‐life often undergo a pseudo‐adolescent period of excessive sexual experimentation and public declarations that might have been preventable had their adolescence been less emotionally constricted by fear, stigma, and internalized homophobia (D’Augelli & Grossman, 2001). § Coming to grips with the grief involved in lost adolescence and young adulthood is often part of the process of coming out in mid‐life, as is the perceived sense of betrayal of loved ones. §On the other side of disclosure is the acquisition of a new‐found sense of integrity and authenticity. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 22

Later-Life Coming Out Factors § Coming out in later years is often distinguished from the way the coming out process is navigated in earlier periods in that there is typically less deliberation, strategizing, and agonizing about disclosure (Grov, et al. , 2006). § Rather, seniors are likely to suddenly make an announcement to family members or friends. § Even though we live in a time of progressive social change with increased visibility and inclusion of LGBTQ people, it is important to remember that today’s LGBTQ older adults came of age in an era that was far less affirming of their identities. §Seniors, in particular, are likely to remember a time when being gay, lesbian, bisexual or transgender was an underground affair and subject to random law enforcement and psychiatric interventions (Katz, 1976). CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 23

Later-Life Coming Out Factors: The Impact of HIV/AIDS § Another important factor to consider related to the lived identities of LGBTQ seniors is the legacy of HIV/AIDS. § For many individuals who lived through the early days of the pandemic, the multiple losses of loved ones and close friends, “discredited” grief processes (Goffman, 1963), intense stigmatization and discrimination surrounding the diagnosis, large scale caregiver fatigue, and inexplicable survivor’s guilt left many gay and lesbian individuals with damaged interpersonal capacities and an internalized aversion to LGBTQ identities. § Others emerged with an enhanced sense of pride and self‐determination to live their lives with strength and courage (Wierzalis, Barret, Pope, & Rankin, 2006). §For many senior citizens considering coming out, the shadow of HIV/AIDS continues to impede their decisions. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 24

Implications for Practice: Risks and Resilience § LGBTQ clients need help exploring decisions about disclosure, especially anticipating potential implications and responses from family and friends. §Practitioners need to be ready to balance providing emotional support for the courage it takes to consider coming out with suggesting caution and thoughtful actions about potential repercussions. § Deciding to come out constitutes an important developmental milestone often seen as a distinctive marker in the life of the individual. §A second important realization necessary for workers to convey is that while this milestone is truly significant, coming out is actually the first of an ongoing series of disclosures that will continue throughout life (Morrow, 2004). §As distinct from those who identify as heterosexual or cisgender, LGBTQ individuals must continue to “come out” in new social settings and wherever heteronormative and cisgender assumptions dominate. The important practice implication for workers is to effectively communicate that this process involves a skill that gets better over time and with practice. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 25

Implications for Practice: Risks and Resilience § It is important to help clients realistically assess risks and consequences of coming out given the contexts of their social environments and significant relationships. §Being able to engage in authentic and genuine self‐representation is clearly associated with improved health and mental health outcomes (Remafedi, 1987); however, it is important to accurately assess for any potential harm that may result from coming out. §In fact, some practitioners may have to support clients through periods of actually “not coming out” for their own safety (e. g. , a youth who may be struggling with coming out to hostile parents and risk being kicked out of their home). §Besides identifying where potential risks may be, it also involves identifying and mobilizing available networks of family or friends who may be supportive or allies when it is time to come out. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 26

Implications for Practice: Risks and Resilience § Encouraging clients to more fully examine their inclinations regarding sexual orientations and gender identities is in no way meant to suggest the practitioner should actively discourage coming out. §However, engaging clients in thoughtful reflection and encouraging informed decisions about coming out can often prevent unnecessary stress, avoid disruption and damage to important relationships, and avert potential harm. §Often, it becomes necessary for the practitioner to provide direct guidance and education regarding accurate knowledge about LGBTQ issues (Morrow, 2006). CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 27

Implications for Practice: Risks and Resilience § Signorile (1995) suggests that LGBTQ individuals explain that the reason they are disclosing something as private as sexual orientation or gender identity to family or close friends is because of the love and importance one feels for those being disclosed to. §However, it is also important that the practitioner help prepare the LGBTQ individual for reactions from family and friends that may not be immediately supportive. §Professionals might suggest that those disclosing consider how long it has taken them to come to accept their own sexual orientation or gender identity, which may help with being patient with friends and loved ones who may be just now confronted with this news. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 28

Implications for Practice: Risks and Resilience § Proctor and Groze (1994) caution that even when a young person or adult experiences a supportive and positive coming out reception, the risk of suicide and self‐harm is extremely high in the hours and days following the actual coming out. §The sense of not being able to turn back, of having sealed one’s fate with the public disclosure, can result in sudden remorse, fear, depression, and suicidal ideation. §This becomes even more perilous when the individual is met with rejection, expulsion from the home, loss of status, or having been publicly “outed” by someone else. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 29

Case Scenarios The following case scenarios will highlight some potential practice challenges when working with the LGBTQ community and factors associated with coming out. The cases may be used as in‐class group assignments or for homework based on the needs of the course. The cases are followed by several questions for consideration. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 30

Case Scenario: Rosie is a 12 year old young lady who identifies as transgender to her teacher and classmates at a local urban grade school. Rosie has the full support of those at her school and feels very comfortable there. However, Rosie is afraid of going home each day as her mother (Adela, age 38 and divorced) is very non‐accepting of her transgender identity. Adela is also very religious and of Mexican decent and will only call Rosie by her birth name of Roberto. Rosie has come to you as her school counselor for guidance in how to more strongly come out to her mother and “make her accept who she really is”. Rosie feels as though her mother does love her, but refuses to accept the fact that her “son” is no longer her ”son” but is now her daughter. Rosie reports some depression and enjoys drinking alcohol with her friends because it helps her ”escape” the pain from being at home with her mother. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 31

Case Scenario: Questions for Consideration Consider the following questions with regard to your work with Rosie in therapy: 1. What practices or strategies would be important to utilize in your work with Rosie ‐ or potentially with Rosie and her mother? 2. How can you best support Rosie and address her mental health and health needs at the same time? 3. What types of issues would you want to address in supervision? CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 32

Case Scenario: Edward & Francis Edward is a 70 year old, bisexual, African American male who is currently dating Francis, a Caucasian, 65 year old, gay male. Edward is seeking couples therapy as they have recently been struggling with coming out to his children with regard to his bisexual identity and his relationship with Francis. Edward’s children are 46 and 43 and live in another state with their children. Francis wants to be a support for Edward, but also finds it challenging as Edward’s children are very negative, unaccepting and have rejected their “straight” father as being bisexual and think it is “just a stage”. Edward is torn between his children and Francis and has honestly discussed closeting himself to “make things peaceful” with his kids. CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 33

Case Scenario: Questions for Consideration Consider the following questions with regard to your work with this Edward and Francis: 1. What practices or strategies would be important to utilize in your work with this couple? 2. How can you best support Edward and address his conflict between his children, his identity and his relationship? 3. How would you navigate Edward’s comments about closeting his identity and relationship? 4. What types of issues would you want to address in supervision? CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 34

National Resources and Web Links AARP o http: //www. aarp. org/relationships/friends‐family/aarp‐pride. html American Civil Liberties Union. Know your Rights: A Guide for Trans and Gender Nonconforming Students o https: //www. insideoutys. org/wp‐ content/uploads/2012/07/transstudent_kyr_20120508. pdf GLBT National Help Center o http: //www. glbthotline. org/ GLSEN. When a Student Comes Out to You o http: //www. glsen. org/blog/when‐student‐comes‐out‐youtoday‐or‐any‐day Human Rights Campaign. A Resource Guide to Coming Out. o http: //www. hrc. org/resources/resource‐guide‐to‐coming‐out It Gets Better Project o http: //www. itgetsbetter. org/ CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 35

National Resources and Web Links PFLAG o http: //community. pflag. org/page. aspx? pid=539 Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE) o http: //sageusa. org/about/what. cfm? gclid=CL‐Oq. MT 6 k 80 CFQi. Qa. Qod 49 s. NWg The Trevor Project o http: //www. thetrevorproject. org/section/YOU CHAPTER 5: THE COMING OUT PROCESS OXFORD UNIVERSITY PRESS 36

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