Mental health articles

Sexual Minorities: Lesbian, Gay, Bisexual, and Questioning Youth
Th e previous decade has witnessed an unprecedented upsurge in the willingness
of students to bring lesbian/gay/bisexual/transgender (LGBT) concerns
to college counseling centers. Th is is partly attributable to the high visibility of
alternative sexualities in the media (Will and Grace, Queer Eye for the Straight
Guy) and the coming out of popular fi gures, such as Ellen Degeneres, Audre
Lorde, and Melissa Ethridge (Savin-Williams, 2005). Whereas previously
students could dismiss homoerotic longings as mere chumship or benign
curiosity, denial is more diffi cult as cultural discourse increasingly focuses
on homoeroticism and gender bending. A case in point is the celebration of
the “metrosexual”—a heterosexual man so secure in his sexuality that he can
embrace manicures and eyebrow plucking.
To help students resolve sexual orientation issues, clinicians should
be knowledgeable about typical homoerotic development (e.g., see Savin-
Williams & Cohen, 1996). A thorough assessment begins with a detailed
sexual history, including fi rst same-sex attractions, sexual behaviors,
coming out to self, coming out to others, relationships, parental reactions
and family problems, harassment, stressors, social support network, and
coping strategies (substance abuse, eating disorders). A therapist must also
recognize that clients’ homoeroticism may be incidental to their identifying
complaint and that the aforementioned variables may contribute more
to dysfunction than does the sexual orientation per se (Cohen & Savin-
Williams, 2004). For example, cultural homonegativity can generate selfhatred,
distorted self-concept, and relationship instability among sexual
minorities. Th e HIV/AIDS epidemic has created an atmosphere of dread
and loss that further contributes to social marginalization and fear of abandonment.
Yet, counter to prevailing stereotypes, there is immense diversity among sexual minorities—some are far more similar to heterosexuals of
their own gender than to other sexual minorities. Sexual minorities may be
sexually inexperienced or promiscuous, suicidal or resilient, gender typical
or gender atypical.
Homoerotic clients may be reluctant to disclose their attractions and behaviors
for fear of negative responses from providers, as happened in this case.Anticipated discrimination stimulates hypervigilance for signs of homonegativity
and may lead to delayed treatment (Cohen & Savin-Williams,
2004). Th erapists therefore must convey support and nonjudgment, or else
refer the client to another clinician. Appreciation for diversity can be communicated
by gay-affi rming posters and symbols (pink triangle), gay magazines
(Th e Advocate, Out) and information pamphlets (e.g., “Homophobia”
[Th ompson & Zoloth, 1990]) in the waiting room, and prominently displayed
affi rmative gay books in the therapist’s offi ce. Intake forms should avoid the
assumption of heterosexuality by assessing sexual orientation, identity, and
behavior and providing the options “with males, females, or both.” Sexual
identity terms should include heterosexual, lesbian, gay, bisexual, questioning,
uncertain, and other (space provided for elaboration) (Cohen & Savin-
Williams, 2004). A therapist further conveys reassurance by adopting the
client’s vocabulary (e.g., avoiding the medicalized and pathologizing term
“homosexual” in favor of “gay”) and rejecting erroneous characterizations,
such as that homosexuality is a psychological defense, there exists a single
“gay lifestyle” or community, gay and lesbian relationships are predominantly
about sex rather than deep emotional intimacy, everyone is really bisexual, or
all bisexuals are actually gay or lesbian. Finally, clinicians ought to be aware
of community resources and refer to knowledgeable and compassionate mental
health and medical specialists.