Can you remember the days when The American Psychiatric Association labeled homosexuality as a mental illness? I can, as can just about anyone over the age of 50, as the APA only abandoned this indefensible stance in the early 1970s. And even after the APA grudgingly chose to recognize homosexual attractions and behaviors as a natural variant of human sexual expression, many jurisdictions continued to criminalize same-sex sexual activity. While those antiquated laws are for the most part off the books in this country and other first-world nations, social discrimination nevertheless continues, with many people feeling that the “heterosexual norm” is the only right way to do things, and anything different is either immoral or just plain disgusting.
Happily, these antediluvian opinions are slowly but steadily disappearing, replaced by more positive and accurate beliefs. For example, gays and lesbians are now portrayed positively, sometimes even as role models, on TV and in movies, and gay and lesbian entertainers, athletes, politicians and the like are “coming out” with relatively few repercussions. Furthermore, equality under the law is becoming a (two steps forward, one step backward) reality, with same-sex marriage now legal in 37 states and the District of Columbia. And, somewhat amazingly, the United States Supreme Court, after adroitly sidestepping the issue for a very long time, is currently considering a group of cases that may legalize gay marriage throughout the US – allowing same-sex couples to live their lives openly and honestly, and to experience all the legal rights and benefits that heterosexual couples have enjoyed for many decades, no matter what state they live in. (The Court’s decision is expected within the next few weeks.)
That said, being homosexual still isn’t easy. Homosexuality remains misunderstood and feared, or at the very least frowned upon, in much of our nation. As with racism (also still alive and well in America), this leads to cultural abuse and psychological trauma for just about anyone who does not fit the heterosexual societal norm. This can be especially problematic for children and adolescents as they come to recognize, often at a very early age, that they are different from the majority of their peers. For instance, one 8-year-old boy might have a crush on his male gym teacher while the majority of his peers are more curious about what happens in the girls’ locker room. Even though this boy is pre-sexual, he is almost certainly aware that on some very meaningful level he is not the same as his peers – and he has likely figured out that this is something to hide. This realization, traumatic unto itself, may also underlie other forms of trauma. As such, the developmental arc of homosexual kids tends to differ from that of their heterosexual peers.
Perhaps the best explanation of this developmental arc is the Cass Model of Homosexual Identity Formation, initially described in the late-1970s by Dr. Vivienne Cass. In her 1979 article titled Homosexuality Identity Formation: A Theoretical Model, Dr. Cass delineated a six-stage model of sexual identity development, with stages differentiated based on a person’s perceptions of his or her thoughts and behaviors.
- Stage One – Identity Confusion: This stage is characterized by feelings of turmoil. This is the point at which a person first begins to realize that he or she is fundamentally different from the majority of his or her peers.
- Stage Two – Identity Comparison: This is when the person begins to compare himself or herself to others, typically feeling alienated in the process.
- Stage Three – Identity Tolerance: This is when the person acknowledges that he or she is indeed different and starts to seek out other gay and lesbian people to combat feelings of isolation. However, the individual tends to keep his or her differentness largely private – keeping important secrets and living a double life.
- Stage Four – Identity Acceptance: This stage is characterized by selective disclosure about being gay or lesbian. Nevertheless, the individual generally continues with his or her double life.
- Stage Five – Identity Pride: This stage is characterized by anger, pride and activism. The individual may become immersed in the gay subculture, rejecting non-gay people, institutions and values. This is still alienating and isolating, though in a different way than earlier stages.
- Stage Six – Identity Synthesis: This stage is characterized by movement away from a dichotomized worldview, and the individual is able to accept his or her sexual orientation as simply one aspect (albeit an important aspect) of his or her larger identity and place in the world.
The Cass model has, for the most part, stood the test of time. The only real challenges to it are delineated by Drs. Joanne Kaufman and Cathryn Johnson in their 2004 article, . In this article, Kaufman and Johnson argue that the Cass model may be somewhat less valid today than in 1979 because:
- The model does not take into account the changing sociocultural factors that may impact identity development.
- The nature and level of social stigma attached to homosexuality have lessened over time.
- The linear nature of the model suggests that everyone must go through all six stages to become a well-adjusted homosexual, and this may no longer be true.
In general, however, the Cass model is a good one that is generally well accepted and often quite useful when working with homosexuals in various stages of the coming out process. Of particular note: the first five stages of homosexual identity development are marked by feelings of being different, alienated, ostracized and isolated. And that is a bitter pill for any developing person to swallow.
In truth, even in today’s much more accepting world, unless gay and lesbian kids are very fortunate they receive little or no social or familial support toward letting them know that it’s OK to be gay. More often, they are directly and/or indirectly shamed and ridiculed, and they become hyperaware that being different is a bad thing. Sadly, even the kids who are supported at home can be (and usually are) shamed at school, in sports, and by the world at large, which is still very much a heterocentric place. In other words, one beloved daytime talk show host, one very nice and well-liked gay couple on Modern Family, and one potential ruling from the US Supreme Court just isn’t enough to normalize being gay for most kids. Especially when a significant portion of the population still marginalizes them with epithets like faggot, queer, homo, dyke and quite a few others that are even more unpleasantly demeaning. Homosexual kids can even be traumatized unintentionally with the phrase, “That’s so gay,” which is sometimes used by other kids as a general putdown. Even though this language is typically not intended as bigotry related to sexual orientation, it’s hard for a gay person to not take it that way.
In response to multiple levels of societal shaming, homosexual kids often learn to hide the parts of themselves that seem “unacceptable” (to themselves and/or others). This occurs within the family, at school, in peer play, and in public spaces of all types. Essentially, they force themselves to “butch it up” or, with girls, to “be more feminine,” even though these behaviors may feel completely unnatural. Or, conversely, they might just give in to life as a “sissy” or a “tomboy” with all the ridicule and bullying that typically entails. Either way, these kids’ self-esteem is pummeled relentlessly, with little to no relief. Sadly, most can’t even find an empathetic shoulder with a parent because parents are usually heterosexual and therefore don’t understand (and may be very uncomfortable with) what the child is feeling and experiencing. Needless to say, the impact of not being understood and properly nurtured often carries forward into adulthood, resulting in wariness, distrust of self and/or others, and various other emotional and psychological issues.
For most homosexuals, early-life trauma is twofold in nature. First, there is what is known as identity trauma. This is when the child is picked on or otherwise abused because of his or her individual characteristics (such as gender, race, ethnicity, or, in this case, sexual orientation). Then there is the attachment trauma that develops when that child’s needs are not sufficiently or effectively responded to by a parent (who, as mentioned above, may be entirely loving but still not understand or be comfortable with a child’s nontraditional sexual orientation). Put simply, a parent who doesn’t adequately respond to a homosexual child’s developmental needs, especially if he or she is being bullied (either physically or emotionally) for being perceived as gay, essentially hits the child with a double trauma whammy. When this occurs, the child becomes much more vulnerable to trauma-related disorders both in-the-moment and later in life.
It is important that psychotherapists who work with homosexual clients understand the types and depth of trauma that these individuals have likely experienced, and the ways in which this trauma can and often does affect their development. When working with these individuals, “identity synthesis,” stage six of the Cass model of homosexual development, is the ultimate goal, with the client eventually coming to understand that his or her sexual orientation is a natural and perfectly acceptable part of who he or she is. Additionally, before the client even walks into the room, therapists need to become aware of their own pre-judgments and beliefs about homosexuality, which can potentially result in problematic countertransference.
In no event should a therapist ever try to change a client’s sexual orientation. Sexual orientation is fixed and immutable, and any attempts to alter it are pointless. Furthermore, attempts to change a client’s sexual orientation may actually be harmful, especially to adolescents, because these “treatments” tend to reinforce societal prejudices against homosexuality (and the resultant traumas and consequences that typically ensue). One study found that children who experience significant feelings of rejection because of their sexual orientation – such as what occurs with “gay conversion therapy” – are three times as likely to use illicit drugs, six times as likely to report high levels of depression, and eight times as likely to attempt suicide. As such, it is imperative that clinicians attempt to normalize rather than pathologize what the individual is feeling. Otherwise, more trauma will occur and development is likely to be further stunted.