By Shianna Ali
Lesbian, gay, bisexual, transgender, queer individuals and those who otherwise identify as a minority in terms of affectional orientation and gender identity/expression (LGBTQ+) have a higher rate of mental health concerns than their heterosexual and cisgender counterparts[i]. One of the reasons for these increased mental health concerns may be that LGBTQ+ individuals are often stigmatized and marginalized by society, thus fueling mental health concerns and inhibiting appropriate mental health care[ii],[iii]. In the coming out process, LGBTQ+ individuals are reminded of these stressors and can become at risk for mental health concerns[iv],[v]. Hence, when coming out, individuals require coping, social support, and intrapersonal strength in order to develop resilience against such mental health stressors[vi],[vii]. However, counselors may lack the therapeutic competencies to assist LGBTQ+ individuals throughout the coming out process.[viii],[ix],[x],[xi]. To help fill this gap, this article utilizes the Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling’s competencies to highlight the important facets to address when addressing coming out concerns in counseling.
Coming out is often seen as a linear, one-time process, however, the reality is that coming out is a multilayered, ongoing process that occurs throughout the lifetime[xii]. Simplifying the coming out experience by assuming that coming out occurs once can cause a counselor to miss stressors that clients are experiencing when triggered to disclose. In order to assist clients, counselors must be able to broaden their definition of the coming out process.
Coming out often occurs at intrapersonal and interpersonal levels. Individuals who have experienced coming out share that when considering coming out, it is beneficial to first consider the internal process in which an individual explores identity to create a strong foundation to prepare for future interpersonal processes[xiii]. For example, consider the case of James who identifies as a gay cisgender male. Due to familial values, James has internalized homophobia which affects his mental health. If James does not address such concerns prior to disclosing to others, he is at risk for having such stressors strengthened and subsequently experiencing increased mental health concerns. Additionality, while consideration of gender and affectional orientation may be of particular importance if a client shares coming out concerns in counseling, it is important for counselors to be mindful that these attributes may not encapsulate a client’s overall identity. Further, an ethical and culturally competent counselor will utilize an intersectional framework[xiv] to illuminate other important aspects of identity (e.g., ethnicity, religion, occupation). Utilizing this view counselors can help clients recognize key aspects of identity that may inform their coming out considerations.
The interpersonal aspect of coming out is recurring and is influenced by a variety of factors (e.g., society, family, peers) that may overlap or interchange. The cycle of coming out can be used to help conceptualize the interpersonal dimension of coming out. A client enters the cycle when considering disclosure, then proceeds to discern whether disclosure is the best decision within that context, and finally, the client decides whether or not to disclose xii. According to the cycle of coming out, while the decision to disclose identity is the impetus for the interpersonal portion of the lifelong coming out process, it is important to consider the two prior phases of awareness and assessment. When using this model, counselors can help clients recognize that each scenario of potential disclosure may be different. For example, Sam, a transgender female shares in counseling that she had a positive experience discussing her gender and gender expression with her siblings. In counseling, Sam shares that while she was previously worried, she is eager to disclose to her parents now that disclosure with her siblings was much easier than anticipated. In this situation it is important to validate Sam’s previous experience and enthusiasm for her future disclosure. However, it is important to help Sam understand that each scenario is different. Honoring individuality, it is helpful to help Sam consider that her parents may not react as her siblings did. Proactive processing can help Sam to acknowledge her strengths and develop resilience prior to disclosure.
Valuing the concept of congruence, counselors must be careful in pressuring clients to disclose. Additionally, just because a client has previously disclosed, it does not mean that the next disclosure is automatically warranted. It is essential for counselors to help clients to recognize both the potential benefits and consequences that pertain to disclosure. Counselors should be mindful of the struggles clients may experience when considering coming out in order to validate experiences. Additionally, counselors have the potential to help clients to highlight their strength and overall ability to develop resilience despite coming out stressors. Overall, counselors have the ability to help clients to recognize coming out stressors, adequately prepare, and sufficiently process their coming out experiences. Further, by addressing coming out concerns in counseling, counselors may help to pave the path coming out growth[xv][xvi], or gains to personal well-being that would have occurred without coming out experiences..
Helpful Questions To Consider Prior to Disclosure
Who would you like to share with?
What is your relationship or history with the person you would like to share with?
What is _____ like?
What is ____’s stance on LGBTQ+ rights?
What are your reasons for wanting to share with ____?
Do you feel safe telling ___?
How do you think ____ will react?
How would you handle being teased or bullied?
What would you do if your conversation does not go as you hope?
Would you be okay if you lost communication with ___?
Would you be able to allow _____ time to process?
Do you have supportive people in your life?
Who are the supportive people in your life?
What is your living situation?
Are you independent?
Are you in danger?
Are you questioning your identity?
[i] Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697.
[ii] Hatzenbuehler, M. L. (2014). Structural stigma and the health of lesbian, gay, and bisexual populations. Current Directions in Psychological Science, 23(2), 127-132.
[iii] Savin-Williams, R. C. (2001). A critique of research on sexual-minority youths. Journal of Adolescence, 24(1), 5-13. doi:10.1006/jado.2000.0369
[iv] Baams, L., Grossman, A. H., & Russell, S. T. (2015). Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth. Developmental Psychology, 51(5), 688-696. doi:10.1037/a0038994
[v] Budge, S. L., Rossman, H. K., & Howard, K. S. (2014). Coping and psychological distress among genderqueer individuals: The moderating effect of social support. Journal of LGBT Issues in Counseling, 8(1), 95-117. doi:10.1080/15538605.2014.853641
[vi] Meyer, I. H., Schwartz, S., & Frost, D. M. (2008). Social patterning of stress and coping: Does disadvantaged social statuses confer more stress and fewer coping resources? Social Science & Medicine, 67(3), 368-379. doi:10.1016/j.socscimed.2008.03.012
[vii] Needham, B. L., & Austin, E. L. (2010). Sexual orientation, parental support, and health during the transition to young adulthood. Journal of Youth and Adolescence, 39(10), 1189-1198. doi:10.1007/s10964-010-9533-6
[viii] Bidell, M. P. (2012). Examining school counseling students' multicultural and sexual orientation competencies through a cross-specialization comparison. Journal of Counseling & Development, 90(2), 200-207.
[ix] Farmer, L. B., Welfare, L. E., & Burge, P. L. (2013). Counselor competence with lesbian, gay, and bisexual clients: Differences among practice settings. Journal of Multicultural Counseling and Development, 41(4), 194-209.
[x] Israel, T., Ketz, K., Detrie, P. M., Burke, M. C., & Shulman, J. L. (2003). Identifying counselor competencies for working with lesbian, gay, and bisexual clients. Journal of Gay & Lesbian Psychotherapy, 7(4), 3-21.
[xi]Ali, S., Lambie, G. W., & Bloom, Z. D. (2017). An exploratory factor analysis of the sexual orientation counselor competency scale: Examining the variable of experience. The Professional Counselor, 7(3), 223-237.
[xii] Ali, S. & Barden, S.M. (2015). Considering the cycle of coming out: Sexual minority identity development. The Professional Counselor, 5 (4). 501-515.
[xiii]Ali, S. (2017). The coming out journey: A Phenomenological investigation of a lifelong process VISTAS. Retrieved from https://www.counseling.org/knowledge center/vistas/by-subject2/vistas-client/docs/default-source/vistas/the-coming-out-journey
[xiv] Lee, C.C.. & Ali, A. (In Press). Intersectionality: Understanding the complexity of identity in counseling across cultures. In C.C. Lee (Ed.) Multicultural issues in counseling: New approaches to diversity (5th Ed.). Alexandria, VA: ACA
[xv] Vaughan, M., & Waehler, C. (2010). Coming out growth: Conceptualizing and measuring stress-related growth associated with coming out to others as a sexual minority. Journal of Adult Development, 17(2), 94-109. doi:10.1007/s10804-009-9084-9
[xvi] Ali, S. & Lambie, G. W.(in press). The impact of strengths-based group counseling on LGBTQ+ young adults in the coming out process. Journal of Gay and Lesbian Mental Health.
Shainna Ali is a counselor educator and owner of Integrated Counseling Solutions in Central Florida. Dr. Ali is passionate about highlighting the importance of mental health awareness, assessment, and care in living a happy and healthy life. Her areas of focus in research and practice include identity and culture, emotional intelligence, trauma, and creativity in counseling. For more information on Dr. Ali please visit www.shainnaali.com