Unit 3 FD A

McGoldrick, M., Preto, N. A. G., & Carter, B. A. (2015). The expanding family life cycle: Individual, family, and social perspectives (5th ed.). Pearson. https://bookshelf.vitalsource.com/books/9780134001180 Chapter 6 Sexuality and the Family Life Cycle Tracey Laszloffy Learning Outcomes

 Define the terms sex, gender, gender assignment, gender identity, transgendered, gender roles, and sexual orientation.

 List and describe five factors that influence individual and family development with

respect to sexuality.

 Describe common messages about gender and sexuality and the corresponding feelings and behaviors that stem from them.

 Explain how a family’s cultural norms, including religious affiliation, social class,

ethnicity, migration and racial background, influence development with respect to sexuality.

 Examine how some of the principles that organize U.S. society shape our relationship

with sexuality.

 List and describe factors that inhibit or impair sexual satisfaction in couple relationships.

 Describe changes in a couple’s sexuality during pregnancy and when a family has young children.

 List and describe challenges associated with sexual development during adolescence.

 Explain changes in sexuality that occur during midlife and later life.

 Describe how sexuality relates to an understanding of the family life cycle.

Introduction Sex is elemental. Without sex, the continuation of our species would be impossible. At the same time, it is one of the most complex aspects of human experience. It consists of a synergistic interplay of biological, psychological, familial, spiritual, cultural, and societal forces that are exceedingly difficult to unravel. An exploration of human sexuality must begin by untangling the confusion created by the language we use to discuss issues of gender and sexuality (Lev, 2004). For example, the terms sex and gender are often used interchangeably, but they refer to two different, although highly interrelated, concepts. Sex is a biological phenomenon that is determined by five factors,

including chromosomes (e.g., the presence or absence of a Y chromosome), sex hormones, gonads (ovaries or testes), the internal reproductive anatomy (uterus or testicles), and external genitalia (vulva or penis). Most human beings are born with either a male or a female sex, although sometimes a person is born with ambiguous sex organs and is thus considered intersexed (World Health Organization, 2010). Gender on the other hand is a cultural phenomenon. It is a socially constructed experience that societies overlay onto the biology of sex. Most societies have constructed and therefore only recognize two possible genders that correspond with the two biological sexes, male and female. However, just as the biology of sex is not absolutely binary, many people experience gender in ways that extend beyond the simple either/or duality of male and female. There are several dimensions of gender that must be considered. The first is gender assignment that occurs at birth and is determined by a newborn’s biological sex. Gender identity is an internal experience. It refers to the gender that persons feel themselves to be. While in most cases this corresponds with the gender that is assigned at birth based on one’s biological sex, this is not always the case. Transgendered individuals experience an internal conflict between the gender they feel themselves to be and their biological sex/gender assignment. In fact, it is important to clarify the meaning of the frequently cited term Transgendered. This is an umbrella term that refers to a wide range of gender experiences and presentations. And finally, the issue of gender presentation is tied to the term gender roles that are behaviors that individuals engage in and communicate their gender outwardly to others. Gender is a social construction and as such, each culture has its own particular way of constructing gender categories and the behaviors that are appropriate to each. However, there is a high degree of similarity across cultures to the extent that most societies are organized around patriarchal norms. Gender systems that are constructed in accordance with patriarchal norms confer men with greater access to social power, resources, opportunities, and rewards than women. Even in modernized Western cultures where there has been a strong shift toward more egalitarian ways of enacting what it is to be “male” and “female,” patriarchal assumptions continue to influence how people think and behave as men and women. Sexual orientation refers to the gender(s) that one is attracted to in relation to the gender that one is. For example, persons who are attracted to members of their opposite gender are considered heterosexual, while those who are attracted to members of their own gender are deemed homosexual, and those who are attracted to people of both genders are regarded as bisexual. Sex researchers now understand that sexual orientation (like gender) is not as dichotomous as once believed and instead it is defined by a continuum. Conceptualized in this way, many people probably are neither exclusively heterosexual nor homosexual, but instead lean more heavily (though not purely) in one direction versus the other. Variation between people is more likely a matter of the degree to which one leans toward one end of the continuum or the other. Most studies on human sexuality approach this subject from an individual perspective. They focus on the process of biological maturation and how this leads to adult sexual development and experience. This framework is a necessary component of understanding human sexuality, but it fails to capture the wider and more complex landscape of human sexual experience. Human

sexuality is a relational phenomenon and as such it is important to consider it within a social context. This focus on the socially constructed and symbolic interactionist dimensions of sexuality is consistent with the perspective that was first advanced by John Gagnon and William Simon beginning in the 1960s. Their work posed a dramatic counterpoint to the biologically based paradigm that had previously dominated gender and sexuality research. They argued that a complex set of culturally shaped meanings and symbols organize human sexual experience and the subjective understandings individuals have of their gender and sexuality (Kimmel, 2007). This perspective heavily informs our approach to the study of human sexuality by locating it within a family context, and specifically, within a family life cycle framework. Moreover, we will examine how human sexuality develops, is experienced, and is expressed over time and from one generation to the next within the interlocking contexts of family, culture, and society. Sexuality: Individual and Family Development Individual and family development with respect to sexuality is influenced by many factors. This chapter considers five factors: (1) family boundaries; (2) family beliefs and messages about gender and sexuality, and the feelings and behavior patterns that stem from these; (3) intergenerational patterns related to gender and sex; (4) cultural norms; and (5) societal organizing principles. Boundaries Boundaries in families regulate how a family system functions. They regulate who is responsible for what, and how family members relate to and interact, both with each other and with people outside the family. Boundaries define where one person ends and -another person begins. Boundaries in families -exist along a continuum from rigid to loose. The more deeply a system’s boundaries lean in either extreme, the less functional the system is. Healthy families have clear boundaries that fall somewhere in the midrange between rigid and loose. Such systems allow some kinds of information and contact to flow freely while simultaneously buffering against the flow of other kinds of information and contact. Families that have clear boundaries also have adaptable boundaries that change as the family evolves through its life cycle. Boundaries become firmer or more flexible to support the developmental demands of individuals and the family over time. For example, in families with young children there is a need for a firmer boundary around how sexual issues are addressed. Some information is shared but tailored to the developmental limits of young children. This might mean that parents focus on teaching their children the difference between “good touch and bad touch.” Moreover, because even very young children sometimes fondle their genitals, in families with clear boundaries parents do not react with shock or shaming. Instead they normalize the pleasure that comes from self--touching while also teaching children when, where, and under what circumstances such touching is -appropriate. In families with adolescents, boundaries need to soften to allow for a greater flow of information related to sexuality. Parents of adolescents need to allow more direct and explicit discussion of and education about sexual issues. Family systems with rigid boundaries enforce extreme separation between family members and prohibit open, direct discussion of sexual issues or expression of even the most limited sexual behavior. When a family’s boundaries are too rigid, children receive minimal sexual information

from their parents, and minimal permission to ask questions or raise issues for discussion. When sexual issues do come up, they tend to arouse disapproval and shame, thereby forcing sexual thoughts, feelings, and behaviors underground. As a result, young people enter puberty with little preparation for the changes they are about to undergo, or they are armed with information they obtained from peers, the media, and the Internet which may prove more harmful than having no information at all. Case Illustration The Bergens—A Case of Rigid Boundaries The Bergen family was characterized by extremely rigid boundaries such that family members had minimal interaction and shared very little about themselves with each other. Dirk, the oldest son of four boys, had been a boy scout from the time he was very young, and was very close to his scout leader, Mr. Frankel. Because there was so much distance in Dirk’s family, he was hungry for attention and connection and Mr. Frankel was like a surrogate father in many ways, guiding and nurturing Dirk. However, when Dirk was 12, Mr. Frankel’s attention crossed the line and he began molesting Dirk sexually. Dirk was conflicted because he did not like Mr. Frankel’s sexual advances, although he hungered for the attention and affirmation he received. Confused and ashamed Dirk grew increasingly depressed, but neither of his parents noticed. The rigid boundaries in the family helped make Dirk vulnerable to Mr. Frankel’s exploitation. These boundaries also fostered a climate where Dirk did not feel permission or safety to open up to his parents about what was happening, nor did his parents notice their son’s increasing sullenness and depression. Conversely, families with loose boundaries are defined by extreme closeness between family members to the extent that individuals have a hard time perceiving the distinction between their own thoughts, feelings, and needs; and the thoughts, feelings, and needs of other family members. Such families are defined by a great deal of emotional and psychological overlapping. In terms of sexuality, families with loose boundaries do not establish adequate limits and they lack appropriate prohibitions. Consequently, there is too much exposure and access to sexual content and activity, and too much permission to act out in sexually irresponsible ways. Families with loose boundaries fail to recognize or uphold age-appropriate parameters around sexual material and activity that can be damaging for children. Children raised in such families are not taught how to set limits with other people about what is comfortable or appropriate; hence, they are more vulnerable to experiences around intrusion and violation. Case Illustration The Mishras—A Case of Loose Boundaries The Mishra family was characterized by extremely loose boundaries. Because the family of five lived in two-bedroom house, the middle child, Reena, slept on the couch in the living room between the ages of 4 and 16. This in and of itself was a reflection of the family’s economic status, not a boundary issue. However, it was not uncommon for Mr. Mishra to awaken in the middle of the night and come into the living room to watch television, sometimes watching pornography. Reena was disturbed by her father’s behavior but felt powerless to address it. Most of the time, she pretended she was still asleep and tried to not hear the television. This behavior reflects how loose the boundaries were in the Mishra family. Moreover, there were several occasions when the family was on vacation when they all shared a single hotel room. Again, the single room was not an issue, but the fact that Mr. Mishra sometimes pressured his wife to have sex with him while his children were presumably asleep in the next bed further reflected their

loose boundary and a disregard for how exposure to sexual issues affected the children. The loose boundaries in the Mishra family left Reena doubting her ability to hold onto herself and set and maintain limits with others. Consequently, she avoided intimacy and by the age of 30 she was still a virgin and had never had a serious romantic relationship. Sexual beliefs/messages and resulting -feelings/behaviors All families are governed by particular beliefs and messages about gender and sexuality and these dictate how family members’ feel, behave, and interact. These beliefs and messages can be overt and covert, but either way, they organize how people conduct themselves and how a family functions. Figure 6.1 presents some examples of common beliefs and messages about aspects of gender and sexuality and the corresponding feelings and behaviors that stem from these. Intergenerational patterns related to sex and gender Families evolve through time and across generations. Hence, much of what occurs in a given family at a given moment in time is heavily influenced by what has been inherited from previous generations. The sexual genogram by Hof and Berman (1986), which is highly compatible with a family life cycle perspective, is a tool for conducting a multigenerational assessment of a family that focuses on identifying how a family’s sexual legacy over several generations may be affecting its current development. Recently, Belous, Timm, Chee, and Whitehead (2012) have updated the sexual genogram to more fully reflect diverse experiences and contemporary issues. Informed by a Queer-Critical theory lens, they have argued that traditional approaches to genogram construction are inherently heteronormative and use discriminatory symbology. “Particularly, the use of different symbols to distinguish differences in gender, sexual orientation, and relationship status intrinsically privilege one group over another; labeling groups of people as ‘different’ and requiring separate symbols and construction methods. It is due to this that the changes to the general construction and interpretation of the sexual genogram are proposed, including gender, sexual orientation and attraction, relationship lines, sexual communication and sexual environment” (p. 284). Following along with the idea that the sexual genogram is a vital tool that can aid in the process of gathering information that focuses on issues of gender, sexuality, intimacy, and power in a family system, below are a series of questions that were adapted from Hof and Berman (1986):

 What are the overt and covert messages in the family regarding sexuality, intimacy, your body, and masculinity, and femininity?

 How have the family’s boundaries encouraged or discouraged expressions of sexuality

and -intimacy?

 What family members were the most comfortable with issues of sexuality and how was that expressed? Who was the most uncomfortable with issues of sexuality and how was their discomfort expressed?

 What were the relationships between power, sexuality, and gender in your family?

 How do you think your family’s cultural background has influenced how it has handled

issues of sexuality, intimacy, gender, and power?

 What attitudes were expressed in your family about sexual violence? If there has been/is sexual violence in your family, how is this handled and addressed?

 Were there issues related to sex and intimacy that generated shame and guilt? For whom?

 Were there family “secrets” regarding sexuality and intimacy (e.g., incest, unwanted

pregnancies, abortions, affairs)?

 How do you perceive your sexuality? How does your partner perceive his/her sexuality?

 What questions have you had about sex or intimacy in your family that you never asked? If you were to ask, who would you most likely ask?

 Are there ways you wish your family system were different with respect to issues of

sexuality/intimacy, gender, and power?

 How do you imagine other family members would answer these questions? Cultural norms

Families have unique cultural identities that influence their development, composed of various factors including religious affiliation, social class, ethnicity, migration, and racial background. Religion, Sex, and Sin Of all the dimensions that comprise a family’s cultural background, religion is one of the most influential with respect to how a family experiences sexuality. All religions communicate specific notions about gender, sex, and power that influence family development, even in families that do not necessarily have a strong religious sense. Most religions convey a great deal of negativity about sex that creates a context of shame and guilt. Virtually anyone who was raised in a family where religion was a facet of their upbringing has been subjected to, and has internalized, some degree of sexual shame and guilt stemming from the belief that sexual desire, activity, and pleasure are bad, and much more so for women than for men. Many religions also teach that sex is only permissible when it occurs between a man and woman, within the confines of marriage, and most specifically, for the purposes of procreation. This further contributes to shame and guilt for those who elect to engage in pre-marital or extra- marital sex. As ecofeminist scholars have pointed out, many pre-agricultural and pre-industrial societies were organized around earth-based religions where the feminine principle, fertility goddesses, and nature symbolism were preeminent. But eventually, these earth-based religions were crushed under the weight of the patriarchal, militaristic sky-gods of Judaism, Christianity, and Islam (Merchant, 1980). These religions are inherently dualistic and thus they divide the world into opposites and assign differential value to these opposites such that one is valued and one is devalued (e.g., good/evil, light/dark, male/female, and spirit/flesh). In this way, maleness is associated with the “higher order” realms of mind, spirit, and culture/technology, while femaleness is associated with the “lower order” realms of the body, the flesh, and the earth/nature. From this perspective, sexuality is deemed bad, sinful, and dangerous to the extent that it operates at the level of the flesh, and thus is inherently a lower-order function associated with femaleness. Hence, the sin that is found in sex is rendered inherently female (Warren, 2000). While most religions discourage sexual feelings and activity unless it occurs within marriage for procreation, female sexuality tends to be more heavily restricted, censored, and shamed than male -sexuality. In this context, boys are raised to believe their sexual feelings and impulses are normal, “-manly,” and healthy, while girls are taught to deny theirs or to be ashamed of whatever desire they may understand themselves to be feeling. The effect this has on couple relationships is that men are more likely to be comfortable with their bodies and in expressing themselves sexually, while women are more likely to struggle, which contributes to tensions related to how often and in what ways couples are sexual. Within patriarchal religions, women are stripped of the power to control their own sexuality and to act authoritatively on behalf of their own needs and desires. The proliferation of pornography

and the sexual abuse of women is the logical extension of these underlying dynamics, all of which have their roots in patriarchal religious principles. Social Class Social class is another factor that shapes sexual attitudes, behaviors, and experiences. For example, middle-income teens tend to delay first intercourse longer than low-income teens. One possible reason for this difference may be that low-income adolescents have greater pressures to grow up quickly and assume adult roles earlier than their middle-income counterparts. Moreover, while girls and women of all social class groups have unintended pregnancies that lead to childbirth, middle-income teens have fewer than low-income teens. Furthermore, while abortion rates overall have dropped in the last decade, they have risen about 25 percent among low- income girls and women (Jones, Finer, & Singh, 2010). The intersection between social class and power also shapes how sexuality is experienced, viewed, and treated. The social marginalization and devaluation that poor and working-class people are -subjected to infiltrates sexuality throughout the life cycle. Given the extent to which violence against women is tolerated by society, poor and working-class women are especially vulnerable. They are sexually assaulted at higher rates than their middle- and upper-income counterparts, and are treated as less credible victims when they report their victimization. Class bias contributes to assumptions that the sexual violation of poor and working-class women is somehow “natural” to their social class because their poverty renders them slightly “less human” (e.g., wild animal nature) and therefore as somehow deserving of, and even enjoying their victimization. In her work on sexual violence, Phipps (2009) has pointed out that to have one’s sexual violation taken seriously in a patriarchal society, a woman has to be viewed as respectable and this is often based on how well she performs stereotypical femininity, which is undeniably linked to class standing. The influence of class on how sexual violence is treated also affects men. Although there are no significant class differences in the rate with which men commit acts of sexual violence, poor and working-class men are more often arrested, prosecuted, convicted, and subjected to harsher sentences than men from higher income groups (Phipps, 2009). Ethnic/Racial Background Ethnic and racial groups each have their own set of values, attitudes, and beliefs about sex that regulate behavior. For cultures that have strong religious influences, there is a tendency toward more conservative sexual attitudes that include viewing sex as dangerous and threatening. Because families are embedded within their ethnic and racial cultures, they absorb these ideas that organize family interactions and relationships over time. For ethnic and racial minorities, experiences with social marginalization and devaluation influence how their sexuality is viewed and treated. The dehumanization that often occurs of ethnic and racial minorities contributes to perceptions that they are more “animalistic,” and therefore, more sexual and more prone to sexual misconduct as part of their “nature.” This makes women of color in particular more vulnerable both to sexual violence and the secondary violence of having their violation made invisible in the courts and in the society.

Societal organizing principles An examination of some of the principles that organize U.S. society and shape our relationship with sexuality must begin with an acknowledgment of the highly conflicted relationship our society has with sex. On one hand, deeply embedded Judeo-Christian values contribute to a view of sex as sinful and shameful. On the other hand, a media-driven, consumer culture pushes sex incessantly, using it to sell everything from movies to automobiles to food. These mixed messages about sex are confusing and reflect a deep underlying ambivalence about sexuality as something to be both reviled and revered. Societal ambivalence about sex creates a context where there is excessive exposure to sex, but this exposure is narrow and incomplete. On one hand, sex is everywhere. Yet what we really know and understand about the depth and complexity of sex is greatly limited. Individual and family development occurs against the backdrop of this societal ambivalence. Whatever sexual issues and dynamics families are contending with, they do so within a social context that floods them with sexual imagery and content, and yet only offers the most meager consideration of the deeper, more complex aspects of human sexual experience. Monogamy One of our society’s most deeply embedded organizing principles is a conviction in the sanctity of monogamy. Mainstream U.S. society regards monogamy as the only truly acceptable way to have a long-term relationship. In many ways, it is regarded as the foundation of our social order. Because our society places such a high value on monogamy, when extra-marital (or extra- relationship) sex occurs, it morally frowned upon and tends to arouse tremendous hurt, guilt, shame, anger, and disillusionment. Yet, as much as monogamy is socially valued and as much as infidelity is shunned, the reality is that over the course of married life in the United States, infidelity occurs in roughly 25 percent of relationships (Whisman & Snyder, 2007). Capitalism and Patriarchy Two organizing principles of U.S. society that powerfully shape how sex is viewed and treated are capitalism and patriarchy. Capitalism turns sex into a commodity that can either be sold directly or used to sell other goods and services. There are entire industries, both legal and illegal, organized around selling sex. On the legal side, pharmaceutical companies sell sexual enhancement drugs such as Viagra and Cialis; manufacturers and retailers sell sexual aids and toys; movie producers and distributors make and sell pornographic videos and magazines; and even an -assortment of professionals including doctors, -therapists, and sexual surrogates make money by helping people to have more or more satisfying sex. On the illegal side, prostitution and the sex trade all profit from the sale of sex, and often in ways that involve extreme exploitation and abuse of women and children. Additionally, capitalism uses sex as a vehicle to sell other products and services. Patriarchy establishes and reinforces male dominance over women and children. Under patriarchy, attitudes toward sex vary depending on whether the participants are male or female. Since men are valued and empowered within a patriarchal system, male sexuality is deemed positive and is encouraged and admired. Conversely, since patriarchy devalues and subjugates women, their sexuality is portrayed as dangerous (and therefore as something that must be controlled by men), and as bad and shameful (and therefore as something that must be repressed

and denied). There have been periods in human -history (e.g., the Han Dynasty of ancient China, pre-conquest Mexico) when female sexual desire has been recognized, honored, and treated with sacredness. However, patriarchy has been an organizing principle of most societies across time; hence, -female sexuality has been degraded and punished throughout much of recorded human history. Because of the differential valuation attached to femaleness and maleness, boys develop greater comfort with their bodies and their sexuality earlier on than do females. The mere fact that boys start to masturbate on a regular basis around ages 8 or 9, while girls typically do not begin until at least mid-adolescence reveals the differential level of comfort they have with their bodies and their sexuality. The differences between boys and girls with regard to early awareness and expressions of sexuality have implications for how men and women experience and express their sexual desire during adulthood. In general, men feel far greater latitude to acknowledge and act upon their sexual desire than do women, who generally internalize the prohibitions and negativity about their desire. Recently, the sexual revolution has heightened women’s freedom to express themselves sexually and experience deeper levels of physical fulfillment. Nevertheless, female sexual desire is still regarded as dangerous and shameful and in countless ways, expressions of liberated female sexual desire are punished. For example, if a woman has the audacity to pursue and express her sexual desire without -apology, she is likely to be labeled a slut. To survive this, Wolf (1997) explained that most girls learn early on that they must split their sexuality off from “-legitimate” identity. This involves joining with boys to condemn other girls who have dared to act upon their sexual desire. They learn to target the girl who most embodies their sexuality, thereby making those girls the scapegoat for all of the badness that society attaches to female sexuality. The interaction of patriarchy and capitalism objectifies women’s bodies and their sexuality, thereby fostering a climate that leads to sexual violence against women and children. Despite progress in the area of gender equality and increased public awareness of sexual violence, women are routinely abused sexually. Nearly one in five women reports being raped at least once in their lifetime (National Center for Injury Prevention and Control, 2012) with most victims knowing their attackers (Centers for Disease Control and Prevention, 2010). -Moreover, it is estimated that at least 60 percent of rapes are never reported. Among female rape victims, 42 -percent were raped before the age of 18 with 93 percent of juvenile sexual assault victims knowing their -attackers (Bureau of Justice Statistics, 2000). It is estimated that one out of four girls and one in six boys will be sexually assaulted by the time they are 8 years old (Truman, 2011). Adding insult to the injury of sexual assault, patriarchy contributes to a perception that when women are sexually abused, somehow, they are responsible for their victimization. Recently, for example, in response to complaints filed by students, several prominent universities, including the University of North Carolina at Chapel Hill, Occidental, Swarthmore, Dartmouth, Yale, and the University of Colorado at Boulder have become the target of federal investigations for failing to adequately address reported sexual assaults (Kingkade, 2013). At Occidental University, when a student went to a Department of Public Safety (DPS) officer to report a sexual assault at a fraternity, the officer told her “women shouldn’t go out, get drunk and expect to not get raped.”

In other cases, where investigations found the perpetrators to be guilty of rape they received minimal punishments such as being assigned book reports and brief suspensions (Baker, 2013). Sexuality Over the Family Life Cycle There are a variety of factors that influence how human beings experience, understand, express and/or repress, and generally relate their sexuality. This section focuses on examining how familial and cultural patterns and dynamics intersect with individual and family life cycle stages to shape human sexual development and experience. Couplehood The coupling experience is greatly influenced by what we learned in our families about sex while growing up, and hence the sexual thoughts, beliefs, and feelings we internalized. For example, growing up in a family that has repressive ideas about sexuality or growing up in a family with indiscriminately open sexual attitudes can complicate the process of dating, mate selection, and the formation and maintenance of an intimate couple relationship. The majority of Americans become sexually active at some point during adolescence, although most people do not marry until later in life. In 1970, the average age for first marriage was 22, but by 2010 it had increased to 27 (U.S. Census Bureau, 2011). In fact, fewer people marry now than in the past with fewer than half of U.S. households comprised married couples. Since the idea that sex must be saved for marriage has less power now than it once did, many young adults have multiple sexual partners prior to coupling or marriage, and unmarried coupling occurs much more frequently than in previous generations. Sexuality within a couple relationship may serve various functions including procreation, to satisfy physical desires, to achieve emotional closeness and intimacy, or as an abuse of power. -Conventional wisdom implies that sex is natural and therefore should come naturally in couple relationships. There are a number of factors, however, that tend to inhibit or impair sexual satisfaction in couple relationships. First, despite the proliferation of sexual imagery and information available in today’s society, what most people know about sex is limited to the technical aspects. While most adolescents get some kind of sex education in school and an informal sex education from peers and the media, few are exposed to more in-depth information about the emotional and relational aspects of sexuality (Shoveller, Johnson, Langille, & Mitchell, 2004). Hence, many adults find themselves limited when it comes to how to identify, express, and experience sexuality in ways that address its more complex psychological and relational dimensions. Second, many women have internalized negative views about their bodies and their sexuality and this makes it exceedingly difficult to have a healthy sexual connection with a partner. Additionally, the widespread sexual abuse of girls and of some boys imposes another complication on healthy sexual functioning in adulthood. Yet, perhaps one of the greatest impediments to a healthy couple sex life is that few people enter relationships understanding how to participate in ways that promote real -intimacy and connection. Sex in a relationship over time is only as good as the quality of the couple’s intimacy. Noted couples and sex therapist David Schnarch (2010) has done extensive research demonstrating that many of the sexual problems that couples experience are rooted in the struggles they have establishing and building intimacy. While popular notions of intimacy

portray it as a state of excessive connection and fusion, in fact, real intimacy is reflected in the capacity to balance connection and belonging on one hand, with autonomy and separateness on the other. Unfortunately, there are few places in today’s society where we teach this principle. As a result, most adults have a very limited view of what constitutes intimacy and how this relates to healthy, satisfying sexual functioning. The result is that many couples struggle with some kind of sexual dissatisfaction, at least at some point in their relationship. For many people, the typical “solution” to frustrations in their couple relationship is to have an affair. While it is more common for men to stray outside of their relationship in response to sexual frustration or dissatisfaction, infidelity for both men and women is very often a response to unmet intimacy needs. The difference is that many men process their intimacy needs in sexual terms, but when time is taken to unpeel what is driving their sense of dissatisfaction, like women, most men find that they are struggling with how to be intimately connected in a meaningful way. In a similar vein, couples and sex therapist Esther Perel, author of Mating in Captivity (2007), has argued that contrary to popular wisdom, too much connection and “we-ness” undermines desire and sexual satisfaction. She has explained that love may require closeness, but desire requires distance, transgression, surprise, and play. Couples who are able to maintain some autonomy and respect for each partner’s unique individuality, and who are able to remain open to novelty, curiosity, experimentation, and exploration, are better able to nurture passion and eroticism in long-term relationships. With respect to affairs, Perel noted in an interview with Polly Vernon that, “When you have an affair, this is rebellion! This is not a mild act! We have affairs to beat back the sense of deadness. We have affairs not because we are looking for another person, but because we are looking for another version of ourselves. It’s not our partner we seek to leave with the affair, it’s ourselves. It’s what I’ve become that I don’t like. It’s how I’ve truncated myself. That there are parts of me that I have been so out of touch with, for decades” (Vernon, 2010). Perel has explained that there are many different ways partners can strive to balance connection with separation, and in so doing, keep themselves and their eroticism alive. One such way involves consensual non-monogamy. “Perel sees non-monogamy by consensual agreement becoming more acceptable and integrated into marriage in the future, much as pre- marital sex has become an accepted norm and monogamy now means having one sexual partner at a time rather than one for life” (Booth, 2013, p. 92). Among gay and lesbian couples, well-known couples researchers like Pepper Schwartz (1998) and John Gottman (2003) have demonstrated that LGBT couples are similar to heterosexuals with respect to the relationship challenges they face and the pathways they follow to achieve intimacy and satisfaction. One way in which differences have been observed is with respect to rates of sexual frequency. Specifically, there is some evidence that gay male couples have the highest sexual frequency, while lesbian couples have the lowest, often referred to as “lesbian bed death” which is the tendency among lesbians to have virtually no sex after several years of being together. There is no clearly demonstrated reason for these differences. One of the most popular explanations is that rates of sexual frequency are tied to gender differences. Since men tend to initiate sex more often than women, the rate of sexual activity is likely to be higher where both partners are men and lower when both partners are women (Peplau, Fingerhut, & Beals, 2004). Additionally, gay and lesbian couples also have to negotiate their relationship and their sexuality

within a social context that is devaluing and marginalizing, which creates an added layer of stress that heterosexual couples do not have to face. Pregnancy We live in an age when women are having babies across a wide spectrum of the life cycle. In some cases, pregnancy occurs during adolescence. In most cases, this means sex came first and what followed was an unexpected pregnancy, which involves high degrees of anxiety and distress. In terms of planned pregnancies, women delay childbearing longer now than any time before, with the average age of a first birth occurring around 25, and a growing number of women having children into their late 40s (Mathews & Hamilton, 2009). In these cases, sex is secondary to pregnancy. It serves as a means to an end and in some cases sex is entirely removed from the equation, as with in vitro fertilization. A common complaint when couples are trying to get pregnant and having difficulties is that sex often feels contrived and robotic, like something they are being asked to perform on a schedule and therefore resent. During pregnancy, couples can continue to experience a normal sex life. It is only in the latest stages of pregnancy that sex is discouraged primarily because it becomes uncomfortable for women. Following pregnancy, most women are physically able to resume normal sexual activity within several weeks after giving birth. However, the massive hormonal changes their bodies have undergone, coupled with the psychological and emotional shifting that refocuses their energy onto their newborn child, tend to result in diminished sexual activity. It is not uncommon for men to feel slighted during this period of time, missing sex with their partners and feeling secondary to the needs of their children. Young children and families After the baby’s first year, it is common for couples to resume more regular sexual activity, unless the woman becomes pregnant again. With the inclusion of children, the challenge many couples face is how to create time for their relationship. The trap many fall into is that they relate primarily as parents and not as a couple, or in worst case scenarios, women assume virtually all parenting responsibilities and men gravitate deeply into the world of work. When this occurs, couple relating, which includes sex, becomes extremely limited. The quality of their parents’ sexual life influences what children learn and come to feel about sex in general, and specifically about their own sexuality. Whether parents are coupled (either with each other, or with other partners) or single, how they feel about their bodies, how often they have sex, and their overall degree of sexual satisfaction affect their mood and disposition. How parents think and feel about sex in general and their sexuality specifically influences how they raise their children and this in turn influences how their children come to think and feel about -sexual issues and themselves as sexual beings. Case Illustration Selena Selena grew up with a single mother, Rosetta. Her father left the family when Selena was 2 and never contacted her after that. Her mother was an attractive, successful professional woman who dated frequently and had had a series of relationships with men that never lasted long. As early as

age 5, -Selena remembered overhearing her mother -having sex and the enjoyment this seemed to bring her. Yet she also observed her mother’s intense discomfort with her body, to the point Rosetta refused to be seen in the summer in a bathing suit. This exposure to her -mother’s body image issues and sexual practices greatly influenced Selena from an early age. By the time she was a young adult, her view of her body and sexuality had been greatly shaped by this early -socialization. Upon seeing a therapist for the first time, Selena explained that her mother was an -enigma to her. She was aware of her body image struggles and yet she also observed the ease with which her mother was sexual with a variety of men. Selena explained that she had internalized her mother’s body image anxiety, so much so that she refused to allow anyone to see her naked. She also disliked the number of men her mother had dated and had vowed that she would never do that herself. Now that Selena was finally in a relationship with a man she deeply loved, she was struggling with how to be sexual with him since she could not tolerate the thought of him seeing her naked. The therapist pointed out that there were two different issues relative to her mother that Selena disliked: (1) the ease with which her mother engaged in multiple casual sexual relationships and (2) her mother’s negative feelings about her body. The therapist also pointed out that Selena had chosen to reject the first of these for own life, yet she had adopted the second one. The therapist suggested that the most powerful way to be true to herself would be to continue to choose to be sexual only within the context of committed relationships and to choose to embrace her body and share it freely with someone she loved. Doing both of these things would disrupt the legacy from her mother that she feared and disliked. That was a new way for Selena to think about her situation and it helped her to free herself of the anxiety she had held from her mother’s history. Adolescents and families Adolescence, by its very nature, is characterized by identity confusion, uncertainty, questioning, and experimentation. It is normative for adolescents to have questions about who they are and how they fit into the world. Hopefully, this stage of uncertainty occurs in a family system that provides young people with the space to be confused, to question, and to experiment, while simultaneously holding them accountable through the application of clear and consistent -boundaries and rules. However, because many families manifest some underlying anxiety about sexuality, there are often unstated prohibitions against openly discussing sex or engaging in sexual behavior. As a result, many teens struggle to explore sexual issues with minimal parental guidance, nurturance, or support. A study conducted by the U.S. Centers for Disease Control and Prevention revealed that approximately 35 percent of high school students are sexually active and almost half of them have engaged in sexual intercourse (Doyle, 2007). The average age of first intercourse is 16.9 years for males and 17. 4 years for females. Age of first intercourse varies by race and social class. The average age for White teens is 16.6, 15.8 for African American teens, 17.0 for Hispanic teens, and 18.1 for Asian Americans teens (Smith, 2006). For low-income families, the age of first intercourse is much earlier at about age 14. The process of adolescent sexual exploration and discovery is complicated by two common risk factors: unplanned pregnancy and contracting a sexually transmitted disease (STD). The human brain develops from back to front and hence the last region to fully mature is the prefrontal

cortex. This is the part of the brain that controls executive functions including foreseeing and weighing the consequences of behavior, impulse control, delaying gratification, inhibiting inappropriate behaviors, modulating intense emotions, and processing multiple sources of information when faced with complex situations (Casey, Jones, & Hare, 2008). Because most adolescents lack the brain maturation that is required to use good judgment when faced with potentially risky situations, they are more apt to engage in high-risk behaviors even when they have been informed of the potential consequences. Given their limited brain maturation, despite being educated with the facts, many teens fail to employ protective measures to prevent unplanned pregnancies and STDs. Every year, an estimated one in four sexually active teens contracts an STD (a quarter of all new cases of sexually transmitted infections) (Doyle, 2007). Yet teen pregnancy rates have dropped 25 percent for teens between the ages of 15 and 19 between 2007 and 2011, and since 1991 the rates have been cut in half (National Center for Health Statistics, 2012). Nevertheless, one in three girls who have sex before the age of 20 gets pregnant (Martin, 2011). Often, the prospect of having to tell one’s parents greatly compounds the stress of unplanned teenage pregnancy. For teens whose families have a strong religious orientation, a confession of this nature can be especially stressful. An admission of pregnancy also exposes the fact that one was engaged in sexual activity outside of marriage. Teens who fear the reactions that such an admission might provoke may choose to terminate a pregnancy to avoid parental anger, disapproval, and shaming. It is estimated that about one third of teens who get pregnant have abortions and in most of these cases, their parents are not aware (Guttmacher Institute, 2013; Jones & Boonstra, 2004). For teens who choose to carry their babies to full term and either raise them or give them up for adoption, their lives and the lives of their families are nevertheless altered forever. For adolescents who may not be exclusively heterosexual, questions about their sexual orientation are often a source of stress. The process of trying to define one’s self sexually is complicated by the extent to which the surrounding environment assumes heterosexuality. As a result, most sexual minority youth must struggle to understand themselves sexually, while living in a society and in families that may not offer the kind of openness, support, and encouragement they need for healthy identity experimentation and development (Stone Fish & Harvey, 19). Andrew Solomon (2013) explained that families often struggle to provide appropriate support to sexual minority youth who are trying to understand and define their sexual identity. Solomon views families as having both vertical and horizontal dimensions of identity. The vertical dimensions consist of attributes and values that are passed down from parent to child across the generations, both through strands of DNA and also through shared familial and cultural norms. The horizontal aspects involve traits that are not inherited from our families. He says that being gay, lesbian, or bisexual are often horizontal identities because most sexual minority children are born to straight parents and have to learn what it means to be who they are from places outside their families. This is also the case with being transgendered, having a disability, being a genius, and so forth.

Heterosexual adolescents also engage in a process of exploring and experimenting with their -sexuality, but they do in the context of messages from society and their families that are consistent with their sexual orientation. Hence, they have the opportunity to explore their sexuality without having to struggle with outside questioning and disapproval of their sexual orientation. Midlife Some midlife families have delayed childbearing and are contending with raising young children in middle age, while others are launching or have launched children and are faced with rediscovering who they are independent of their parenting role. Still, for those adults who have never had children, there is less of a dramatic shift in focus in the middle years, although they must still contend with anxieties that commonly arise with each passing year and the corresponding decline in once taken-for granted capacities (e.g., decreased eyesight, a slower metabolism, more “aches and pains”). As the population at large lives longer, and with lifestyle improvements related to nutrition and fitness, sexuality remains an important component of living a quality life for most people. For women, menopause can be both a blessing and a stressor. While many women are relieved not to have to contend with their periods, it can be a challenging process to redefine oneself as a woman who can no longer reproduce. Also for many women at menopause, intercourse becomes painful physically, since the reduction in estrogen causes vaginal dryness. For men, sexual arousal begins slowly declining after early adulthood and by midlife, men often have more difficulty achieving and sustaining an erection. Forty percent of men experience some type of erectile dysfunction by midlife (Keesling, 2006). While this can contribute to feelings of inadequacy, with the increased use of medications such as Viagra and Cialis, many more men are able to manage erectile issues more effectively. Families with older family members Human beings are fully capable of remaining sexual well into their old age. Depending on their physical health and energy level, older people can desire and experience sex as a regular part of their lives. It is not uncommon for sexual activity to become less focused around intercourse and more around kissing, touching, and caressing each other. The extent to which older adults are able to experience and enjoy sex in their later years is affected by the family’s overall openness toward sexuality, and at the same time, the extent to which older adults express and participate in being sexual also shapes the family. Case Illustration The Mahoney-Corelli Family The Mahoney-Corelli family highlights the importance of viewing cases within the context of a multigenerational framework. This case progresses through several phases of the family life cycle tracking how the family’s boundaries, their sexual rules and messages, the legacy that was inherited from previous generations, and the influence of societal and cultural norms have interacted to shape individual and family development in terms of sexuality.

The Presenting Issue and Assessment The Mahoney family consisted of Angela and Patrick, married for 19 years, and their two children—Frank, age 17, and Patsy, age 15. Angela initiated therapy because she was concerned about Frank who had been caught with a group of friends drinking on school property and was suspended. Moreover, Frank had grown increasingly angry leading to several outbursts against his father and a male teacher at school. Angela was less concerned about Frank’s drinking which she attributed to typical teenage behavior, and was more worried about his increased anger. Patrick was less worried and more irritated with his son, whom he described as disrespectful and suggested that what he most needed was someone to “knock some sense into him.” This comment provoked Frank and angry words were exchanged between the father and son. Patrick told his son he needed to learn how to behave and Frank lashed back telling his father “You’re one to talk about how to behave. Since when is cheating on your wife behaving right?” Frank’s outburst exposed the fact that slightly less than a year ago Angela started to suspect that Patrick was having an affair. After confronting him repeatedly, he eventually confessed. It was also revealed that Frank knew of his father’s infidelity because his mother had confided it in him. And finally, it made clear that Frank’s recent attitude and behavior issues were a reaction to the distress in the parents’ marriage. The therapist maneuvered to loosen the rigid boundary that divided the spouses while firming up the boundaries between mother and children. She did this by asking to meet alone with Patrick and Angela, thereby employing a classic structural technique for reconfiguring subsystem boundaries and restructuring interactions. Now the couple had to face each other without the children to triangulate. During the first session alone with the couple, they revealed that they had struggled sexually for many years. Angela experienced low sexual desire, saying that she had very negative feelings about sex and rarely wanted to be sexual. Patrick, on the occasions they attempted to be sexual, struggled to maintain an erection. Patrick said he did not understand his erectile difficulties because he was attracted to his wife, and did not have this problem with the other woman. It was apparent to the therapist that Angela and Patrick were deeply disconnected from each other and each struggled with feeling unwanted and undesired by the other. Gathering data and constructing a genogram Guided by the assumption that the couple’s dynamics were rooted in intergenerational patterns involving boundaries, sexual rules and messages, and the influence of cultural and societal norms, the therapist gathered information about their histories and worked with the couple to construct a genogram (see Genogram 6.1). Through this process, she learned the following about their histories.

Genogram 6.1 Mahoney/Corelli Family Genogram Patrick’s family of origin Patrick Mahoney grew up in an Irish American family in Boston, the fourth of five children. His parents, Colin and Kate -Mahoney, were Irish immigrants who met in the United States when they were 21 and were married 6 months later. Patrick described his mother as a strong woman who was guided by her religious devotion. He described his father as a quiet, reserved man who operated according to a strict moral code and could be a harsh disciplinarian. Colin had no formal education but was a gifted mechanical designer and invented many ingenious parts for the company that employed him. Unfortunately, he was not a savvy businessman and as a result, his company made a fortune on his designs, but he himself struggled financially throughout his life. Because his sense of pride was largely tied to his ability to provide for his family, he was further humiliated by the fact that Kate, a skilled seamstress, earned a supplemental income for the family with her small sewing business. The Mahoney family was defined by rigid boundaries and emotional disengagement. Because Patrick knew little of his parents’ emotional reality, he was shocked later in life when he found a hidden collection of poetry his father had written. When he asked his mother about it, she admitted that Colin’s secret aspiration was to be a poet, but he had forsaken his desire out of his sense of responsibility to provide for his family. Only then did Patrick realize how much loss his father must have felt around the sacrifices he had made to care for his family. Because of the family’s rigid boundaries and emotional distance, Patrick’s parents never realized that when he was 9, he was molested by a parish priest, while serving as an altar boy. They never

recognized that he had become sullen and withdrawn, although they did notice a decline in his grades that they responded to punitively. Angela’s family of origin Angela Corelli was raised in an immigrant Italian family in Lowell, Massachusetts. Her parents, Sophia and Marco, grew up in rural Italy and a year after marrying emigrated to the United States with their firstborn child, Luigi. Marco worked in a mill and Sophia stayed home to care for and raise the three children they eventually had. She was a devout Catholic and believed it was her duty to serve God, her family, and her community. Marco was also devoted to his family, working long hours to provide for them. At the same time, he had numerous extra-marital relationships. Angela’s family was characterized by loose boundaries between family members and a high degree of closeness. Angela grew up learning that it was important to sacrifice her own needs to take care of others. The blurred boundaries and intense emotional closeness were reflected in Sophia’s reliance on her son Luigi for emotional support. Because she made him her confidant she told him about his father’s infidelities and allowed him to witness the pain this caused her. Luigi in turn shared this information with Angela. Angela perceived her mother as asexual, saying she had gained weight early in the marriage, often wore dark, drab clothing, and spoke harshly of women in the neighborhood who flaunted their sexuality. Her mother taught her that sex was the downfall of men. Angela had a conflicted relationship with her father. She respected him greatly for his strong work ethic and how he provided for his family, but she also resented him for hurting her mother. Becoming a couple and raising their children Patrick and Angela met as sophomores at Boston University and they married shortly after graduating. Patrick wanted to be a writer, but he turned down a job with a small newspaper in favor of a higher paying sales position with a gas company. Angela worked as a teacher until the birth of their first child when she decided to become a stay-at-home mother. Through the years, the dynamics that evolved in the family were characterized by a rigid boundary between Angela and Patrick and a loose boundary between Angela and the children, Frank and Patsy. Angela functioned as the primary caretaker of the children and had an intense emotional connection with them. Patrick was emotionally distant from his family, although he had a soft spot for Patsy whom he idealized. As a function of the loose boundary between Angela and the children, she shared secrets with each of them. When Patsy was 15, she got pregnant which she confided in her mother but never wanted her father to know. Angela agreed to keep Patsy’s confidence and even helped her to have an abortion. With Frank, Angela confided Patrick’s infidelities to him and she shared the anger and hurt she felt. Her husband’s transgression reminded her of her father’s infidelities and the pain that this had caused her mother. An additional stressor in the family was related to financial pressures. Several years earlier, Patrick had taken a new job with another company with the understanding the pay would be better. It turned out to be a poor move because the company was unstable and after only a few

months he was laid off. For the next year, Patrick was unemployed and the family struggled. While he eventually found a new job, the humiliation of not being able to provide for his family was hard on Patrick. Interventions Having gathered a great deal of information as part of constructing their genogram, the therapist guided the couple to identify the intergenerational patterns that had been transmitted over the generations and how these were shaping the current issues in the family. With minimal prompting, Angela and Patrick identified the theme around male infidelity, emotional and sexual distance between spouses, women devoting themselves to home and family such that there was an intense emotional closeness between mothers and children, and men working excessively and being largely disengaged from their children and wives. Following their lead, the therapist emphasized the pattern of men defining their worth in terms of economic success and making sacrifices to be good providers. That led Angela to share that she had just realized that both Patrick and his father had abandoned aspirations that involved writing so they could focus on providing for their families. Seeing this for the first time, Angela was able to access and convey compassion toward Patrick, including thanking him for the sacrifices he had made and the loss he had suffered. Patrick was visibly moved by her expression. Another notable pattern the therapist -highlighted involved women avoiding or feeling negatively about sex. Angela had clearly observed that in her mother, and she guessed that her mother had learned that from her own mother. She could see how she had internalized the negativity that her family and her culture had communicated. The therapist guided her in a deeper exploration of the family, cultural, and societal norms and values that had shaped Angela’s beliefs and feelings about sex in general and her sexuality specifically. Angela admitted that she did not feel like she was a sexual person and deep down, she disliked that about herself. She had always wondered what was wrong with her, although now she was starting to understand her feelings about sexuality as they related to the experiences in her family and even in her culture. The therapist shared with the couple that most families have secrets that often reside at the center of the dysfunctions that haunt family members. She explained that fear and shame are usually what compel people to hold secrets. She cautioned that unless family members were willing to risk truth telling, no real intimacy or healthy relating would be possible. She asked each partner to think about what secrets they might possibly be holding and invited them to consider sharing these in the next session in the spirit of healing themselves, their marriage, and their family. It was this prompt that eventually led Patrick to admit the sexual abuse he had suffered as a child. In speaking this truth for the first time, he admitted he felt a relief he had never known before. It was an unburdening that he had craved his whole life but never felt the freedom to choose for himself. In therapy, with guidance from the therapist, Angela was able to respond with the comfort and reassurance that Patrick desperately needed to hear. While it brought her great trepidation to do so, Angela admitted that she was harboring a secret that was a source of deep inner conflict because it involved one of their children. She required Patrick’s promise that he would not become enraged and lash out in some way that would be hurtful to anyone involved. Eventually, Angela told him the truth about their daughter’s sexual

activity that resulted in pregnancy and abortion. Patrick was mortified. This information devastated the view he had of his daughter and it enraged him that his wife had conspired to help her get an abortion behind his back. With the therapist’s guidance, he eventually was able to -acknowledge feeling hurt that his daughter had not trusted him with something so serious, but he also had to admit that he could understand how scary and painful it would have been for her to risk “falling from grace” in this eyes. Angela pointed out that the abortion was harder on her, as an observant Catholic, than on him, because he did not adhere to religion. Nevertheless, against her own values, she supported Patsy because she realized that given their daughter’s age and emotional state, having the child would have been devastating for her. This was something Patrick could relate to, and eventually, after his initial rage had been vented and dissipated, he was able to express his sadness that his daughter had endured this ordeal and his guilt that he had not helped her to feel safe in coming to him. He also was able to acknowledge the generational repeat that he had not felt able to tell his parents of his sexual abuse and now his daughter had not been able to tell him of her sexual indiscretion. A critical component of Angela’s disclosure to Patrick was that it strengthened the alliance between them while disrupting the parent–child coalition. The therapist explained that they had stopped functioning as a team a long time ago and each had found other ways to direct their energy and to get their needs met. Angela had become overly involved with her children as reflected in Patsy’s seeking support only from her mother in her time of need. Angela’s closeness with Frank was another manifestation of energy that had been diverted out of the marital subsystem. The therapist referred back to the relationship Angela’s mother, Sophia, had had with her brother Luigi. She asked if she saw the similarity and what she made of it. Angela could not deny that she, like her mother, had come to rely on closeness with her son as a substitute for unmet emotional needs in her marriage. This disclosure opened space for Angela to talk about how lonely and neglected she had felt over the years and, with the therapist’s guidance, Patrick was able to hear and validate her feelings and acknowledge his inattentiveness. He admitted he had poured himself in to his work out of desperation to establish his sense of worth as a man and as result he had neglected the people he loved most. Patrick’s admission triggered Angela’s anger because, as she pointed out, work had not been his only source of diversion. At that point, the therapist had to take steps to address and help them heal the damage that had been inflicted by the affair. While healing from the trauma of infidelity takes a long time, it begins with the person who was unfaithful taking full responsibility, genuinely apologizing, and seeking the other partner’s forgiveness. Because of the steps the couple had started to make together, it was easier for Patrick to respond non-defensively to Angela’s anger. With the therapist’s guidance, he admitted his wrongdoing. He explained that he had felt like a failure in so many ways and the affair had been an escape from those feelings. He admitted that until these therapy sessions, he felt like his wife did not value or respect him. He acknowledged that this did not excuse his behavior. It was explanation not justification, and as badly as he may have been feeling, nothing could excuse his affair. At that point, he broke down and expressed extreme remorse saying that he was ashamed for all these ways he had failed his family and he begged for his wife’s forgiveness. Seeing his vulnerability so openly displayed softened Angela. While she still felt anger and would for a long time to come, his admission and

acknowledgment, and his genuine show of feeling moved her. It helped her to respond with reassurance that she wanted them to heal and to reconnect, and she believed that was possible. Gradually, the therapy process was helping to reconfigure the boundaries in the family system. The couple was more engaged than they had been in years and to further strengthen their connection, and to reinforce the de-triangulation of the children, especially Frank, the therapist held a session with just Patrick and Frank. In that session, Frank expressed a lot of anger toward his father. Having been prepped by the therapist, Patrick was able to avoid reacting to his son’s anger and instead he validated his feelings. He also took responsibility for the fact that he had not been present enough in the family and he explained that this was going to change. He shared with Frank that he grew up in a family where his father worked all the time and he learned that to be a good man meant making enough money to provide for your family. He was only now starting to see that was not true and he did not want to teach his son the same wrong message. He told Frank that being a good man meant treating the people you love with respect and giving them your time and attention and that he planned to do that from here onward. While Frank refused to admit in the session that he believed his dad or was comforted by what he had shared, not surprisingly, his behavior and his disposition began to change for the better. His anger faded away and he started doing better in school. The final issue the therapist addressed with the couple had to do with their sexual relationship. The couple was taking important steps to challenge family legacies, to confront cultural and societal norms that had not served them well, and to refocus their energy between them without diverting it elsewhere. With this foundation, their sexual relationship -started to improve. Because Patrick was not -harboring pent up feelings of inadequacy that he felt were reflected in his wife’s eyes, eventually he was able to maintain an erection with her. That in turn was affirming to Angela who had felt sexually rejected in response to his erectile difficulties. His ability to sustain an erection, coupled with the vulnerability he had shared with her, and steps he had taken to be accountable for his transgressions helped her to feel close to and cared for by her husband. Moreover, she was challenging deeply held beliefs about sexuality and herself as a sexual being which was helping her to access desire for him that she had cut herself off from long ago. Conclusion Sexuality is a fundamental and inherently relational aspect of human experience. Any effort to understand human development; the family life cycle; and how individuals, families, and relationships of all kinds grow and change over time must include a focus on sexuality. This chapter has approached the study of sexuality across the family life cycle by considering how a family’s boundaries, its beliefs and messages about gender and sexuality, the intergenerational patterns that have been transmitted about gender and sexuality, cultural norms, and societal organizing principles pursuant to gender and sexuality all interact to shape individual and family development over time. Even when a person or a family is not experiencing sexual problems per say, sex is always a part of the context and their experience. Therefore, any effort to study or understand the family life cycle must consider how human sexuality develops, is experienced, and is expressed over time and from one generation to the next within the interlocking contexts of family, culture, and society.

Chapter 7 Lesbian, Gay, Bisexual, and Transgender Individuals and the Family Life Cycle Deidre Ashton Learning Objectives

 Define the acronym LGBT and explain why LGBT people are discussed as one group in the family life cycle.

 Describe legal impediments LGBT people face when coupling or growing a family.

 Explain how the intersection of cultural identity with sexual orientation and gender

identity can intensify identity development tasks and add more complexity to the processes of the family life cycle.

 Recognize the importance of familiarity with LGBT identity development models when

working with LGBT communities.

 Discuss how coming out as lesbian, gay, bisexual, or transgendered impacts individuals and families.

 List and describe challenges and opportunities unique to the development of LGBT

people and their families as they become young adults.

 Describe the challenges and opportunities that LGBT people experience during the coupling stage.

 Discuss how deciding to become parents impacts an LGBT couple and their families.

 Identify how developmental tasks differ during adolescence when a family includes an

LGBT person.

 Explain the challenges and opportunities that LGBT people and their families experience during later life.

Introduction Lesbian, Gay, Bisexual, and Transgender (LGBT) people have been members of families of origin, families of choice, and families of creation across cultures and nations throughout history (Blando, 2012). Prior to the spread of homophobia through Western colonialism, same-sex relationships were socially accepted and well integrated into family structures in many cultures throughout the world (Williams, 1998). The contemporary LGBT civil rights movement marked by the Stonewall rebellion of 1969 has vigorously fought for the legal rights of LGBT people as individuals entitled to fair and just treatment in all areas of life including employment, housing, education, health care, marriage, and family formation. Prior to Stonewall, LGBT people were frequently portrayed as single adults, ostracized from their families of origin, incapable of establishing lasting partnerships, unfit to raise children, and relegated to the “gay ghettos” of

major urban cities. Although there is still much work to be done, the LGBT civil rights movement has made significant strides in establishing and protecting the rights of LGBT people to couple, have children, and be recognized as healthy, productive, moral, and lawful members of families, communities, and society. This chapter focuses on how LGBT people move through the family life cycle. It builds on the framework of Tom Johnson and Pat Colucci’s chapter “Lesbians, Gay Men, and the Family Life Cycle” in earlier editions of this book. The reader will be oriented to the life cycle discussion through clarification of terminology, a review of the current legal status of LGBT families, conceptualization of LGBT individuals and families as multicultural people, and a review of models of LGBT identity formation. The need for clarification of language is related to the generally accepted, erroneous construction of gender and sexual identity as biologically determined. The dominant culture maintains that biological sex determines gender identity, gender identity determines gender role, and gender role determines sexual orientation (Lev, 2004). The terms LGB are categories of sexual orientation or identity (Lev, 2004; Mallon, 2008a; Savin-Williams, 1996). LGB may be the self- selected terms that represent the individual’s sexual orientation, the direction of sexual, affectional, and emotional attraction (Lev, 2004; Mallon, 2008a; Savin-Williams, 1996). Thus, individuals of LGB orientation may have various sexual identities, gender identities, or gender role expressions. For others, LGB may also be the self-selected terms that reflect sexual identity or the individual’s sense of sexuality that integrates biological sex, gender identity, gender role expression, and sexual orientation (Lev, 2004). Among heterosexual and LGB individuals, there may be variation in biological sex, gender identity, and gender role expression. Transgender or gender-expansive (Baum et al., 2012) may be the self-selected terms that reflect experiences of gender identity that fall outside of the dominant culture’s biologically determined, bipolar gender system (Lev, 2004). Among Transgender or gender-expansive individuals, there may be variation in sexual orientation, sexual identity, and gender role expression. In this chapter, the terms lesbian, gay, and bisexual reflect sexual orientation or identity and the terms gender-expansive transgender reflect gender identity. If “LGB” references sexual identity/orientation, and “T” references gender identity, it may seem that we are conflating aspects of identity that are simultaneously related and different by discussing LGBT people as one group in the family life cycle. The reasons for doing so are fourfold: (1) although separate constructs, sexual identity, sexual orientation, gender identity, and gender role are interrelated; (2) LGBT people share in common the experience of transcending the limiting dominant social construction of sexuality and gender identity and thus share histories of marginalization; (3) LGBT people have all been marginalized in the discussion of families; and (4) Bisexual and Transgender people are often made invisible in the literature and in LGBT communities. However, it is critical to acknowledge that while similarities exist, the experiences of these four groups are not identical, and thus there will be variations in family life cycle issues. This chapter overviews LGBT experiences in the family life cycle. The reader is encouraged to study each group separately to cultivate a more nuanced understanding of LGBT people and their families. Current Status of LGBT Families in the United States

Understanding the laws regulating coupling and family growth is essential to working with LGBT-headed families. The LGBT civil rights movement has made great strides in legitimizing the created families of LGBT communities by pursuing the legalization of Gay marriage and adoption of children by LG individuals and couples. Access to marriage The 2013 repeal of section 3 of the Defense of Marriage Act (defining marriage as a legal union between one man and one woman [DOMA, 1996]) by the Supreme Court of the United States was a watershed moment in the movement to grant full marriage equality to same-sex couples. The ruling provides same-sex couples access to some of the over 1,000 federal benefits granted to opposite-sex married couples (American Civil Liberties Union [ALCU] et. al., 2013). The ruling is limited as some federal agencies may base marriage recognition on the laws of the state of residence instead of the state of marriage (ACLU et. al., 2013). The ruling also left section 2 of DOMA in tact allowing each state to regulate coupling (United States v. Windsor et. al., 2013) rendering many couples and families invisible and unprotected. However, at the time of writing this book numerous states and the District of Columbia have granted full marriage equality to same-sex couples (Human Rights Campaign [HRC] 2015, National LGBTQ Task Force [NLGBTQTF], 2014). It is expected that by the summer of 2015 the Supreme Court of the United States will determine the constitutionality of state prohibitions of same-sex marriage (Beam, Loller, Sewell, & White, 2015). The Transgender community remains more vulnerable than the LGB community. A preexisting marriage of an individual who transitions from one sex to another remains valid (American Civil Liberties Union 2013). In some states, access to marriage is based on the postsurgical sex of the transitioning partner, while in others it is based on the natal sex of each partner. Transgender couples may experience difficulties accessing benefits granted by marriage because of transphobia, heteronormativity, and cisnormativity. The movement toward marriage equality for all continues as activists pursue passage of the Respect for Marriage Act that would ensure federal recognition of all marriages (ACLU et al., 2013). Family growth LGBT individuals and couples grow their families biologically, through formal and informal adoption, foster care, and by blending families. In states with marriage equality or other forms of same-sex unions, both partners are presumed to be the parents of a child born to them (National Center for Lesbian Rights [NCLR], 2014). In states prohibiting same-sex unions, the non-blood- related parent must establish parental rights through adoption or parentage judgment (NCLR, 2014). Several states prohibit second-parent adoptions by LGB partners, and adoption by same- sex couples, or leave adoption decisions to local jurisdictions (NCLR, 2014). The federal government appears more protective of parent–child relationships than couple relationships as federal law mandates that all states and jurisdictions recognize adoptions regardless of local law (NCLR, 2014). Currently, there are no legal protections for gender-expansive parents (ACLU-NCTE, 2013) and courts have ruled against these parents regarding custody because of their Transgender identity

(ACLU, 2013). Although some courts recognize that Transgender identity is not harmful to child development, they fall short of acknowledging that gender identity is not relevant to child development as evidenced by emerging research (Mallon, 2008b). Advocacy of LGBT civil rights leaders, organizations, and shifts in public opinion are rapidly changing regulation of coupling and parenting. On a daily basis, LGBT individuals, families, and communities demonstrate their resilience in the face of legally sanctioned oppression and defy myth and rhetoric that they are antithetical to family values. Anyone working with LGBT families should consult the laws of their jurisdiction to understand the specific context of that family. Diversity Among LGBT Families LG individuals have been characterized as bicultural because they have been raised in the heterocentrism of the dominant culture (Laird, 1993; Lukes & Land, 1990), but, in fact, LGBT individuals are multicultural as they are also members of various racial, ethnic, religious groups, and social classes, and occupy a range of locations along the continua of gender and sexuality. The diverse experiences, worldviews, and values of LGBT individuals and families are shaped by the intersection of these social locations and are particularly salient as we live in a world that is organized and ranked by these dimensions (Cole, 2009; Moore, 2011; Moore & Brainer, 2012; Singh & Harper, 2012). The intersection of multiple identities is a source of strength, and simultaneously results in the powerful interactive effects of multiple forms of oppression (Bowleg, 2008; Walters & Old Person, 2008, Moore, 2011, Moore & Brainer, 2012). Multiculturalism and intersectionality are the lenses through which LGBT people in the family life cycle are viewed. A national survey of multiracial, Latino/a, Black, Asian, and Pacific Islander LGB individuals revealed that both racial and queer identity were valued by the majority of the over 5000 participants (Battle, Pastrana, & Daniels, 2013a, 2013b, 2013c). Although integration of multiple aspects of identity and active participation in each reference group may be optimal, many LGBT people of color are challenged to choose allegiance to the White, eurocentric LGBT community, or their heterocentric racial/ethnic community. Choosing allegiance to the ethnic/racial community could result in the loss of burgeoning support of the White LGBT communities. According to Greene (1998) and Walters (2008), the racism of White LGBT communities goes further in maintaining white skin, heterosexual, and male privilege, and the heterosexism of communities of color is understood as a survival strategy, as homosexuality can be mistakenly seen as a challenge to the survival of the race. Bisexuality and Transgenderism are viewed similarly within communities of color. These loyalty binds can intensify identity development tasks and add more complexity to the processes of the family life cycle. Models of LGBT Identity Development Familiarity with LGBT identity development models is beneficial to a discussion of the family life cycle, as the family is the context in which identity development takes place and the tasks and processes of LGBT identity development interact with those of the family life cycle. LGBT identity development can begin at any stage of development. It occurs along with, or in the context of, other aspects of identity development such as race/ethnicity (Bowleg, Burkholder, Teti, & Craig, 2008; Lev, 2004; Walters & Old Person, 2008). Some people become aware of

their LGBT identity early; for others, awareness emerges at later life stages (Connolly, 2004a; Herdt & Beeler, 1998; Sanders & Kroll, 2000). Regardless of when LGBT identity development begins, experiences vary. People move around and through the stages at various rates and times, in varying order, and sometimes skip stages without indicating path-ology or arrested development (Lev, 2004; Savin-Williams, 1996; Walters & Old Person, 2008). Models have been developed to explicate the processes by which individuals discover, reveal, and develop a sense of pride in a subjugated sexual or gender identity in a heteronormative world. Each model highlights processes in which individuals move from self-awareness, to disclosure, to identity integration (Cass, 1979; Cass, 1998; Lev, 2004; Weinberg, Williams, & Pryor, 1994). Scholars have criticized the LGB models for being developed largely based on the experiences of White, Western middle-class people, equating behavior with identity, and failing to integrate cultural and historical contexts (Lev, 2004; Moore & Brainer, 2012). In many non- Western cultures and communities of color, identity is not based on the object of sexual attraction (Moore & Brainer, 2012). An individual may love a person of the same sex, be sexually involved, raise children, share a life and not identify as LGB. Savin-Williams (2005) proposes a differential developmental trajectory in which queer youth go through a process that is both like and unlike that of heterosexual youth and also like and unlike other queer youth accounting for within group variation, and multiple pathways into LG identity. The reader is encouraged to become familiar with these models as a starting place for working with the LGBT community, but is reminded to always privilege the pathways to LGBT identity presented by the individuals with whom they are working. Identity Management and Coming Out Just as identity development begins at any stage of the life cycle, so can disclosure or coming out (Mallon, 2008a). Disclosure is an individual and relational process in which LGBT individuals become aware of their sexual identity or orientation or their gender variance and inform others. Many people conceptualize coming out as a one-time event, but because the world is heteronormative, coming out is a lifelong process (Mallon, 2008a) that is better conceptualized as identity management (Connolly, 2012). All of the previously referenced identity models include coming out as part of the identity formation process, as these are recursive processes in that disclosure “redefines” self and self-labeling “drives” disclosure (Savin-Williams, 1996). Disclosure may vary according to familial and cultural norms. Methods of disclosure include both verbal and nonverbal expressions that can be voluntary or involuntary. Today’s youth may not take on an identity label constructed by the dominant LGBT culture, or engage in conventional disclosure (Savin-Williams, 2005). Among people of color, nonverbal signifiers may be privileged over verbal disclosure (Walters & Old Person, 2008) and thus silence may not be an indicator of patho-logy but is likely culturally appropriate (Singh & Harper, 2012). The absence of explicit dialog does not connote secrecy as Battle et al. (2013a, 2013b, 2013c) found that the majority of people of color in a nationwide survey were out to friends and family. Salience of identity may be related to the coming- out processes for LGBT people of color. Black Lesbians and Bisexual women who find their sexual identity more salient are more likely to be out than those who find their racial identity to be more salient (Bowleg et al., 2008). Moore (2011) challenges conventional coming out constructs, identity development models, and labels as representing only one pathway into LGB identity and suggests that coming to Lesbian identity

for Black women is a more complex process shaped by sex, gender, race, and class that she prefers to reference in the more culturally congruent language of “coming into the life.” Families of LGBT individuals also go through a coming-out process shaped by their values, beliefs, existing dynamics, quality of relationships, coping strategies, and oppressive forces (Connolly, 2004a; LaSala, 2010; Savin-Williams, 1996). LaSala (2010) frames coming out during adolescence as a relational process in which the family moves from awareness of the child’s differentness to disclosure/discovery, in which the child may experience relief from anxiety and parents assume the anxiety to acceptance and celebration. Lev (2004) outlines a process for families of Transgender individuals in which families move from a sense of betrayal and confusion to integration of the family member back into the system. Like individual coming out, the family process is not a one-time event, but will be repeated across the life span and in the context of the family life cycle. The Family Life Cycle The family life cycle discussion will focus on the ways multigenerational LGBT families complete the tasks and processes of each stage in the context of multicultural identities, sexual and gender identity development, coming out, heterosexism, heteronormativity, and a biologically determined binary gender identity system. The unique challenges and opportunities of being “other” at each stage will be examined with the understanding that these challenges are not related to sexual or gender identity but rather to the experiences of marginalization and multiple oppressions (Lev, 2004; Mallon, 2008a; Walters & Old Person, 2008). Although the following discussion will address voluntary coming out for the individual and family, it is acknowledged that an involuntary or unplanned discovery can heighten stress and anxiety for the individual and the family. Regardless of life cycle stage, there are challenges LGBT families will commonly experience, including the cumulative effects of heterosexism, heteronormativity, and gender oppression from the larger society resulting in minority stress-generated mental health concerns (Giammattei & Green, 2012). Minority stress is amplified for those who occupy multiple marginalized statuses. The initial response to coming-out is often unpredictable and stressful as relationships can be at risk. Disclosure of an LGBT identity by any family member at any stage may delay completion of tasks, or for adolescents and young adults, it may accelerate launching (Lev & Sennot, 2012). Families grieve their expectations and assumptions about the LGBT family member and determine to whom to disclose, how, and when (Connolly, 2004a; Lev, 2004; Mallon, 2008a). LGBT individuals raised in heterosexual families, where all members are gender conforming and adherent to conventional gender roles, lack role models to inform sexual and gender identity formation, the coming-out process, and the development of survival strategies in the face of sexual and gender oppression (Connolly, 2004a). Families that have experienced racial oppression may see the individual’s LGBT status in opposition to strategies taught to combat racism (Greene, 1998; Walters & Old Person, 2008) and may fail to see these strategies as helpful in combating heterosexism. Families of color may worry that the young adult now has another layer of oppression with which to cope. Dominant culture families who are unaware of experiences of oppression may feel unprepared to help their child cope with the newly declared devalued status. Both dominant culture and marginalized families may support and operate from heterosexist, homo-, bi-, and transphobic ideologies, and therefore may unintentionally

participate in oppressive systems that harm and dehumanize their family members (Connolly, 2004a). They will have to come to terms with their attitudes and beliefs about homosexuality, bisexuality, and gender variance. Even the most accepting families that embrace LGBT friends must face their internalized oppression. Along with challenges come benefits, or at least opportunities, at all stages of the life cycle. Queer youth raised by LGBT parents have role models within the family, and have likely learned LGBT culture, history, norms, and rituals within their families of origin (Luvalanka, 2012). Individuals who lack role models in their families of origin have unique opportunities to name themselves and to create family structure and roles based on needs and preferences instead of existing prescriptions. Similar to communities of color that define family in a broad manner including both blood and non-blood kin in varying functional roles (Boyd-Franklin, 2003; Watts- Jones, 1997; Walters & Old Person, 2008), LGBT communities have adopted this practice forming families of choice (Weston, 1991). In doing so, LGBT communities are finding ways to provide instrumental and emotional support in the face of adversity and a mechanism for transmitting values, norms, knowledge, rituals, and survival skills. Although some LGBT families choose to adopt gender roles rooted in heteronormativity, many families transcend traditional roles and define them based on equality, interests, and talents (Mallon, 2008b). For example, research suggests that among LG couples, family responsibilities and chores tend to be more evenly distributed between partners (Gotta et al., 2011). LGBT families and communities have the opportunity to create rituals helpful in transitioning through the life cycle (Imber-Black & Roberts, 1998). Throughout the discussion of life cycle stages, there is an implicit assumption that every adult wants to couple and raise children. Many healthy, well-adjusted individuals may not partner or parent by choice or circumstance. Remaining single or childless does not represent pathology or exclude individuals from the life cycle process. Single adults, and those who do not parent, have membership, roles, tasks, and meaningful relationships within the contexts of their families of origin and choice, and communities. Leaving home and staying connected: adulthood Launching reflects exiting from one’s family of origin, but young adulthood also reflects entry into a life that is simultaneously independent and connected to the family of origin. Tasks focus on accepting movement in and out of the family system, shifts and renegotiations in the parental (couple) system, forming adult-to-adult relationships between older generations and the young adult, adjusting to changing abilities, health issues, and eventual loss of the older generation. For the single adult, tasks include starting career/work life, cultivating intimate relationships with peers, and assuming financial and emotional responsibility for self. When young adults come out as LGBT to their families at this stage, the process can feel risky, as they may be early in their independence and still experience a heightened need for the support of their families of origin. Yet, queer young adults are not as vulnerable as adolescents and children because they are no longer fully dependent on their families. Furthermore, LGBT young adults may be aware that family of origin support can be replaced or augmented by a developing family of choice or peer network. If the young adult has not come out to the family of origin, being single may allow the system to assume heterosexuality and gender conformance. If the

young adult has come out, then being single may allow the family to view the nonheterosexual or nonconforming gender identity as a phase to be grown out of upon meeting the “right” person. The family of the bisexual single adult child may see bisexuality as a phase and push for opposite-sex dating in an effort to promote heterosexuality. Because entry into single adulthood is a time of restructuring in the family of origin, the young person and the family may struggle with the role and place of the LGBT person in the family as the member may be failing to meet family expectations. When a family member comes out while the young adult is launching, the family may shift attention from launching the single young adult to coming to terms with the newly announced identity of the family member. Young adults may neglect their own tasks to support the newly out member, or to help the family cope with conflict. As young adults establish their work lives and strengthen their peer support networks, they must constantly decide to whom they can safely disclose (Connolly, 2012), and that may impact their relationships and careers. As at other stages, some young adults may choose to lead double lives participating in LGBT communities while presenting as heterosexual or gender conforming in the rest of their lives. The challenges of dating may be further complicated by variation in stage of development regarding sexual and gender identity development (Connolly, 2012) as well as other identity statuses (e.g., race), adding another layer of complexity to this life cycle stage. At first glance, it may appear that an LGBT identity is burdensome to young adults and their families. However, this perceived burden affords the family the opportunity to consciously examine its values, beliefs, and ways of being and relating to one another, as well as the opportunity to create a stronger, more open, and communicative family structure. Some families may break apart, but many families successfully complete this life cycle stage and continue to move forward (Benshorn, 2008; Cramer & Roach, 1988; Griffin, Wirth, & Wirth, 1986; Johnson, 1992; Robinson, Walters, & Skeen, 1989). Case Illustration Randy Randy, a 23-year-old African American man who is close to his multigenerational family of origin was raised in and remains a member of a historically Black, fundamentalist Christian church in a predominantly African American urban, northeast community. While growing up, his family viewed Randy as “soft” and “girly.” Throughout high school, he found himself drawn to activities traditionally reserved for girls and experienced himself as neither man nor woman but transgendered. Randy’s family saw his behavior as sinful and pushed him to repent through prayer and worship. Randy found his family’s urgings intolerable and longed to openly explore his gender freely, to date men, and strengthen his connection to LGBT communities of color. Despite limited income, Randy moved out of the family home, into an LGBT neighborhood, and started dating a new acquaintance. After 3 weeks, Randy invited his new acquaintance to move in with him because he could not afford rent on his own. The acquaintance sold stolen property out of the apartment to earn his share of the rent. The two were caught, arrested, and convicted. Because it was Randy’s first offense, and the court viewed transgenderism as pathological, Randy was referred for mental health treatment. The agency worker supported Randy to explore his gender and to identify and negotiate the conflicts he felt regarding his gender identity, religious beliefs, and family norms. The worker helped Randy to connect to an LGBT affirming

faith community that had its roots in African American spirituality and traditions. Randy and the worker also met several times with his family of origin. Although the family held that Randy’s behavior was sinful, they were willing to provide emotional support and guidance so that he could successfully live on his own with the understanding that they would silently pray for him and that Randy would refrain from discussing his gender identity in their presence. Randy accepted these terms for now, and invited his family to continue to participate in the therapeutic process. Living independently and connecting to an affirming, culturally relevant faith community allowed him to grow in his identity as an African American, Christian, gender- expansive man who is authentically connected to his family of origin. Coupling During the coupling stage, two adults form a committed union while blending their respective families and realigning their relationships with families of origin and choice, and friends. The formation of a healthy committed union may also include multiple partners. Partners in polyamorous unions face additional challenges while living in a heteronormative context that often pathologizes these relationships including challenges related to lack of social and legal relationship recognition. Identifying a partner can be challenging parti-cularly in conservative communities, even when aided by technology (Giammattei & Green, 2012; Lev & Sennott, 2012). The primary tasks of coupling are to solidify intimate bonds with a desired emotional and sexual companion, build a shared life, pursue common goals, support the individual goals of each partner, and formalize the status of the relationship as committed. Coupling may have several unintended or intended outcomes for LGBT people. Coupling may serve as a declaration of sexuality particularly in cultures where nonverbal cues are valued over verbal declarations. Same-sex coupling may also be a signal to the family that being LGB is not just a phase. If a bisexual person couples with a person of the opposite sex, the family may continue its heterocentric assumptions, causing conflict and frustration for the bisexual person (Weber & Heffern, 2008). Most individuals develop their ideas about coupling from familial observations, popular culture, and media. From these sources, they learn values, norms, create the definition of a couple, and develop expectations. Some LGB couples will apply a heterosexual paradigm to their relationship and seek to live by these norms and roles. Others create their own way of enacting couplehood. Tunnell (2012) describes three basic tasks of all couples: (1) creating a couple identity and boundary around the unit, (2) regulating closeness and separateness, and (3) accommodating difference. These tasks can be complex for heterosexual couples but are further complicated by heterosexual privilege and traditional gender role socialization for LGBT couples. Identity and boundary formation are interactive processes involving the couple, their families, communities, and society. There is a recursive relationship among couple recognition, couple identity, and boundary formation. Recognition strengthens identity and boundary formation, and couple identity and boundary formation drive the desire for social recognition (Tunnell, 2012). Families of origin and creation, as well as society in general, serve as sources of recognition. Social recognition includes legal protections and helps to draw the boundary around the couple as a subsystem functioning within larger contexts. Despite the expansion of marriage equality, in

some states the second-class domestic partnership or civil union remains the only option for same-sex couples. Failure to validate the couple may hamper identity formation resulting in stress and conflict for the couple. LGBT couples may choose to physically and or emotionally move away from invalidating sources and move toward affirming sources such as the family of choice. Sexual monogamy is often a presumed boundary marker for heterosexual, dominant culture couples. This is not necessarily the case for queer couples. Thus, an additional task in boundary formation may be decision making regarding sexual exclusivity (Tunnell, 2012). Regulation of closeness and distance within their relationship may be more difficult for same-sex couples because of socialization (Tunnell, 2012). In U.S. culture, men tend to be socialized to be independent and to seek separateness and are often shamed for desiring connection. Women are generally socialized to be interdependent and to seek emotional connection and may be shamed for displays of independence and separateness. Contemporary feminist-informed clinical literature suggests that Lesbian couples desire more intimacy and closeness and do not report what may be seen as fusion as problematic. In fact, Lesbian couples may actually find what is described as enmeshment to be self-affirming, satisfying relational needs, and providing protection against homophobia, heterosexism, and sexism (Connolly, 2012). To their same-sex relationships, men may bring greater expertise in creating separateness, while women may bring greater expertise in creating closeness. Each same-sex couple will need to find a way to cultivate expertise in both areas, and each individual will have to give up participation in socially sanctioned shaming in response to out-of-conventional-gender-role behaviors. Just as closeness may be a protective factor in same-sex relationships, difference may be a threat. In addition, gender role socialization contributes to this threat perception as men have likely been trained in competition and dominance and women in accommodation. Therefore, when difference emerges, men may address it through competition and combat while women may minimize difference by silencing their own opinions and needs. In same-sex unions, partners may have to work harder at accommodating difference or asserting separateness by relinquishing gendered expectations (Connolly, 2012; Tunnell, 2012). The process of joining respective families and gaining familial support will be influenced by whether or not the couple is out. For couples who are out, the degree of familial support may be informed by whether or not the individuals are accepted within their families of origin, whether or not the couple expresses their status in a culturally acceptable manner, the individual family’s attitudes toward gender variance and nonconforming sexuality, and the effects of internalized, intersecting oppressions. In order to join, each family must be willing to come out, among themselves and to the partner’s family. Additional challenges faced by LGBT couples include legal costs. Despite the partial defeat of DOMA, couples may still need attorneys to develop contracts establishing many of the rights automatically granted to heterosexual married couples. These legal contracts are costly and given the variation across states, cannot grant all of the benefits bestowed upon married heterosexual couples. LGBT couples who are members of the dominant racial/ethnic group will have to cope with the effects of heterosexism and homophobia on their relationship (Connolly, 2004b), while LGBT couples of color will face the interactive effects of multiple forms of oppression. Couples may be affected by, and will need to work through, their own internalized homo-, bi-,

transphobia, and heterosexism (Connolly, 2004b). Family members who seem supportive may engage in unintentional invalidating actions such as introducing the partner as a friend, expecting the adult child to privilege the family of origin over the partner, providing separate sleeping accommodations when visiting, or failing to recognize the couple’s anniversary. Couples in which one or both partners are bisexual may have additional challenges. First, because the dominant culture frequently understands sexuality and sexual orientation as binary, sexuality is assumed to be either hetero- or homosexual, so bisexual individuals must decide whether or not to disclose their sexual identity to their partner (Bradford, 2012). If they choose to come out to their partners, the couple may deal with the relational fallout, which may include mistrust, a sense of betrayal, and an erroneous assumption that the bisexual partner will be unfaithful (Bradford, 2012). Often bisexuality is not accepted as complete identity and so both same-sex and opposite-sex partners may be waiting for the bisexual partner to clarify his or her identity (Bradford, 2012). Each partner must explore and understand the meaning of bisexuality, how bisexuality will inform sexual behavior, and if choosing to operate outside of heteronormative constructs of coupling, the couple must make disclosure decisions (Bradford, 2012). Finally, when partnered with an opposite-sex person, the bisexual partner may experience invisibility while also benefitting from heterosexual privilege, generating feelings of shame and guilt (Weber & Heffner, 2008). When Transgender individuals disclose their gender variance as a member of an existing Lesbian, Gay, or heterosexual couple, it may be falsely assumed that the individual wants to terminate the relationship (Israel, 2004). Coming out may send the committed relationship into a crisis, as partners often feel betrayed and experience the disclosure in ways that are similar to learning of infidelity or illness (Lev, 2004). As the couple faces the crisis and moves through the emergence process, both people will address relationship viability, negotiate relationship rules, and address couple sexual identity (Lev, 2004; Malpas, 2012). Like bisexual individuals, gender- expansive people must determine when and if to come out to a partner or potential partner. Many couples in which there is a gender-expansive partner find ways of negotiating this transition, relinquishing their fear, shame, and ignorance about the gender spectrum, and are able to move forward in their lives with the transgender member fully integrated into the family system (Lev, 2004). Some of the benefits and opportunities for LGBT couples are freedom from traditional gender role, to create unique ways of being a couple, and to define the terms of their relationship including who will work, money management, decision making, and addressing issues of sexual exclusivity. LGBT couples may turn to their families of choice to determine how to be a couple borrowing that which is appealing and abandoning what is unappealing. Case Illustration Deborah and Sabrina After 3 years of dating, and cohabitating for 2 years, Deborah who is Jewish American, and Sabrina, who is Irish American, decided to marry. Their families of choice instantly celebrated the decision. Sabrina wanted to include their families of origin in the ceremony, while Deborah did not want to include her family of origin because she was not out to them. Sabrina believed the ceremony presented the opportunity to tell Deborah’s family that they were not just roommates. This difference erupted into intense conflict that prompted the couple to postpone

the ceremony and seek therapy. During the course of LGBT affirming therapy, it became apparent that each partner was at a different stage of identity development, and there were differences concerning their expectations regarding family of origin involvement in their lives. Sabrina and Deborah worked to resolve their differences by clarifying and working through relationship expectations. The couple came to a mutual understanding regarding the role of Deborah’s family in their relationship and Sabrina came to respect the boundary that Deborah had already created. The couple resumed planning their ceremony, which they created by borrowing from their respective cultural traditions. Sabrina’s family of origin was prominently featured throughout the ceremony and a small private dinner was held for Deborah’s family. The couple recently celebrated their seventh anniversary and continues to thrive, in part, due to the continued support of their families of choice and Sabrina’s family of origin, and the couple’s clarification and negotiation of their relational expectations. Parenting: families with young children The primary process of families with young children is integrating new members into the family system. Couples assume responsibility for their children while maintaining responsibility for, and to, each other, and making space for the child. Additionally, familial relationships change and couples help their families adjust to their new roles as grandparents, aunts, etc. Deciding to become a parent brings a host of questions to be addressed. The decision itself is one that is a significantly more conscious process for LGBT couples and individuals. They must determine the method by which they will become parents including donor insemination using a known or anonymous sperm donor, surrogacy, shared custody of children from a prior relationship or encounter, adoption, or formal or informal fostering. Some Lesbian and Gay couples opt to conceive a child together, acting as donors or surrogates for one another, and may choose to parent together. If a known donor or surrogacy is chosen, couples must decide if the donor or surrogate will be in the child’s life, whether the child will have knowledge of that individual’s status, and at what age such information will be shared. Lesbian couples choosing to birth biological children must decide which partner, or if both partners, will become pregnant. Gay men must decide which partner’s sperm or if both will be used in surrogacy. Couples becoming parents through adoption may face obstacles because of heteronormative agency workers. LGBT individuals and their partners may experience difficulties in gaining custody and visitation of biological children from prior relationships. Once the method of having children has been selected, parental rights must be established. While married couples are automatically granted parental rights, LGB couples who do not have access to marriage equality must establish the legal connection of both parents to the child. Decisions regarding becoming parents and protecting parental rights may be class informed, as those with the greatest access to financial resources, medical care, community and familial support have a greater range of options from which to choose (Lev & Sennott, 2012; Mezey, 2012; Moore, 2011). Decisions may also be informed by racial and ethnic norms, for example, more working-class couples of color parent children from prior relationships, or from extended blood and fictive family networks (Moore, 2011). Once these decisions are made and the couple engages in the process of becoming parents, they must also determine what and when to disclose to the families of origin. Regardless of the existing degree of acceptance in the families of origin, having a grandchild, niece, or nephew,

etc., not only increases the visibility of the LGBT individual, but also increases the visibility of the families of origin. Conflict may arise within LGBT families where silence or invisibility is the term for acceptance of an LGBT identity. If a couple has been presenting to their families of origin as friends or roommates, or if the family has been denying the true nature of the relationship, having a child may push the couple to disclose or the family out of denial. LGBT couples must make adjustments in their own relationships to integrate children into the family system. They must renegotiate the boundaries that define their identity as a couple, their roles, responsibilities, expectations regarding closeness and distance, and connections to friends and work. Additionally, the parenting couple must develop or refine their decision-making system as they collaborate to raise their children. New parents must reorganize priorities, making the care and nurturing of their children paramount. Existing couple and family of origin issues may intensify (Mallon, 2008b). LGBT couples must help integrate their new child into their families of origin. They may follow family of origin norms regarding the relationships between the child and other family members or they may create their own standards. The way that family members respond to new children and integrate them into the family may be informed by heterosexism or homo-, trans-, and biphobia, and thus families of choice may take up that life cycle task either in place of, or in addition to, the families of origin. Individuals who come out after becoming parents have additional tasks. They must negotiate being their authentic selves while maintaining family ties and bonds with children and current or former partners with whom they may co-parent. Co-parents, children, and other family members may react with shock. Of course, negotiation of the parent’s identity and transition process become additional tasks for the family (Mallon, 2008b; Malpas, 2012). The co-parent may be confused about the past and present meaning of the couple relationship in the context of the partner’s newly disclosed identity. How children respond may be related to their stage of development. For young children, the disclosure may be meaningless, but for adolescents it can be unsettling as they are dealing with their own emerging sexuality. LGBT parents may feel concerned about how the disclosure will affect their legal rights related to custody and or visitation (Mallon, 2008b). Although it is a complex and often painful process, being true to self and disclosing provides children with a model for how to be one’s authentic self in the face of challenges (Mallon, 2008b). Literature about Transgender parents and the effects of growing up with a gender-expansive parent is extremely limited (Lev, 2004; Mallon, 2008b). Despite the lack of evidence supporting that being raised by an LGBT parent increases the likelihood of nonconforming gender or sexual identities or struggles in these areas, concerns run rampant about the impact of the parent’s gender identity on the gender or sexual identity of their children. Although it is recognized that children raised in families where a parent is transitioning may have difficulty, the expectation is that they will cope in a manner similar to other normative life cycle transitions (Lev, 2004). Families with young children who express gender nonconformity will have the additional tasks of developing coping and advocacy skills to respond to their other children, relatives, friends, schools, and other social institutions, and for incorporating the needs of the gender-expansive child into family life (Lev, 2004). Some young children grow up feeling different but are unable to name the nature of the difference. During adolescence, or later in life, they may come to

understand that difference as being related to their emerging sexual identity, orientation, or gender identity (Lev, 2004; Savin-Williams, 1996). It is the role of the family to provide nurturance, unconditional support, and acceptance as their children discover who they are in the world, and how to name and present themselves. LGBT parents experience unique challenges related to their own sexual or gender identity or related to the nonconforming sexual and gender identities of their young children. Once they become parents, they must learn to cope with the stress related to witnessing their child’s experience of heterosexism, homo-, trans-, and biphobia, and they must teach their children to cope with oppression. Parents must resist the influence of internalized heterosexism that activates in them the hope that their children will be heterosexual or gender conforming (Lev, 2010). They may worry about their children being teased either about their parents’ sexual or gender identity, or about the child’s gender nonconformance. However, the same skills used to cope with bullying for other reasons, or in response to other forms of oppression, are applicable to these situations (Mallon, 2008a, 2008b). Parents must provide their children with language for talking about their family in a manner that is comfortable for the child (Lev & Sennott, 2012). Additionally, the provision of a nurturing, supportive, and loving home is a powerful buffer against all types of bullying and oppression. LGBT families with young children also experience unique opportunities that include transcending the limitations of gender roles and the opportunity to create alternative family structures that are more consistent with the concept that “it takes a village” to raise a child. LGBT families of color may be particularly adept at taking advantage of the support offered by families of choice due to a cultural tendency to define family broadly. There is a significant body of research demonstrating that relationships among family members and the quality of care provided by parents are much more critical and important to the healthy development of children than the sexual or gender identity of parents or family structure (Mallon, 2008b). Case Illustration Esther and Julia When Esther, a Korean American woman, and Julia, a Jamaican woman, celebrated their 10th anniversary, they decided to have a child. They elected to use an anonymous donor and decided that Esther, who was older, would be the first to carry and deliver their child, and in a few years Julia would become pregnant using the same donor. After locating a fertility clinic that would service a Lesbian couple, the two proceeded with their plan. They had a healthy baby girl named Ayana. The baby suffered from severe colic prompting Julia’s mother to stay with the couple for several months to help out. Sleep deprivation, worries about Ayana, lack of privacy, and concerns about their ability to parent disrupted the plan to have a second child and created tension between them. Esther and the baby went to stay with a close friend. Although supportive on the surface, Julia’s mother told her that she was not surprised by their failure, as everyone in their family agreed that these two women needed a man to make a family. Julia sent her mother home and asked that she and other family members think about how they could be a supportive kinship network to Ayana. She pleaded with Esther to return home, sought the support of their family of choice, and suggested that they begin couple’s therapy. Esther agreed, Ayana’s colic improved, the couple adjusted to their parenting roles, renegotiated their relationship, confronted the heterosexism in Julia’s family, and had their second child 4 years later.

Parenting: families with adolescent children Families raising adolescents are focused on revising boundaries to allow increased independence of children, the increasing frailty of the older generation, and movement in and out of the family system. During this stage, the adolescent is separating from the family, individuating, and identifying more with the peer group. Parents are refocusing attention on themselves as a couple (or for single parents dating/partnering), their own life’s work, friendships, and caring for the older generation. An additional task for the family includes integrating the LGBT family member into the system regardless of whether it is the parent or child who is LGBT identified. During adolescence, coming out to oneself and others is often a complex process that can be filled with joy, excitement, pain, fear, loneliness, conflict, acceptance, and rejection. Becoming aware of one’s sexual identity or orientation at this stage may be helpful to the young person, as it may clarify feelings of differentness or feelings that previously may have been confusing (Savin-Williams, 1996). This clarification of misunderstood feelings may also hold true for gender-expansive youth. While teens are often seeking independence from parents, disclosure to the family of origin may be motivated by a desire to be closer to family, to be one’s authentic self, and to enlist support (Savin-Williams, 1996; LaSala, 2010). The closer the young person is to the family, the higher the stakes are for gaining or losing familial support (Stone Fish & Harvey, 2012). If a parent is LGBT or comes out, the social stigma of having an LGBT parent may increase stress and anxiety as the adolescent strives to integrate the parent’s identity with his or her own and to fit in with peer groups (Welsh, 2008). Separation from parents motivated by negative feelings about the parent’s sexual identity or gender variance may result in family conflict. As youth become increasingly aware of negative social attitudes toward homosexuality, bisexuality, and gender variance, concern for the well-being of the family, fear of oppression, and conflicted feelings about wanting to pass as a heterosexual family may emerge (Welsh, 2008). It is imperative that parents support adolescents to cope with these feelings, or locate a trusted adult, mutual support group, or helping professional to do so. LGBT youth who become aware of their attraction to both sexes or the same sex, or are aware of their gender variance, have a much more tumultuous journey than their heterosexual, gender conforming peers (Hunter & Mallon, 2000; Lev, 2004; Lev & Sennott, 2012). The development of positive sexual or gender identities may be the most challenging tasks for LGBT youth when they live in heteronormative or openly hostile families, schools, and communities. Youth raised in LGBT-headed families may worry that their own queer identities will reinforce the heterosexist myth that queer parents cause their children to be queer, thereby pathologizing the entire family and invalidating the adolescent’s authentic knowledge of self (Luvalanka, 2012). They may also feel pressure to be heterosexual or gender conforming in response to parental internalized heterosexism. LGBT parents worry that their children will experience the same oppression that they did and children may delay coming out for the same reason. Although there is a dearth of research concerning the experiences of LGBT youth of color, a few speculations can be made. LGBT youth of color are more likely to be members of collectivist ethnicities; the family is more likely to be inclusive of blood and non-blood kin, community members, and ancestors (Boyd-Franklin, 2003; Walters & Old Person, 2008; Watts-Jones, 1997).

Thus, coming out to the family and community becomes a more complex process, as the adolescent considers cultural norms and the range of responses of a broader, more complex family network that has played a pivotal role in protecting and supporting the youth in a world that is organized by white-skin privilege. Sadly, it can be expected that LGBT youth of color will contend with intersecting oppressions resulting in conflicting allegiances at a time when they most need to locate reference groups in which they feel welcomed, validated, and at home. Parents, especially, are in a position to shape the lives of their LGBT adolescents in a positive way, as studies have demonstrated that parental acceptance has positive impact on self- acceptance among LGBT youth, and that family acceptance significantly enhances self-esteem, social support, general wellness, and protects against substance abuse, depression, and suicidality (Ryan, Russell, Huebner, Diaz, & Sanchez, 2010; Savin-Williams, 1996). As more families, schools, and communities become LGBT affirmative, social and psychological outcomes for adolescents will be enhanced. Case Illustration Sonia Sonia’s parents were called to school by her high school counselor. The counselor had been seeing Sonia for a few weeks out of concern for her declining grades, her withdrawal from school activities, and her overall sadness. On this day, Sonia told the counselor that she thought that her family would be better off if she were dead. The parents, a Latino couple that had been married for 20 years, arrived to the school angry with Sonia because they had to take time from work in response to what they described as a ridiculous statement. Sonia was taken to the local hospital where she was diagnosed with major depressive disorder and referred for psychotherapy. The therapist began meeting with Sonia individually and at times with the entire family. The therapist worked with the family to make room for Sonia’s feelings, to understand the changes in her behavior, and to explore how processes in the family system related to Sonia’s behaviors. During an individual meeting with the therapist, Sonia shared her attraction to both boys and girls and asked the therapist to refrain from disclosing this information to the rest of the family because she feared rejection. The therapist agreed, and as they continued talking the therapist sought to understand Sonia’s concerns while listening for potential sources of support within Sonia’s life. During a family meeting, it was discovered that Sonia’s 19-year-old brother, Roberto, had many Gay male friends and that Roberto saw nonconforming sexual and gender identities as normative. When meeting alone with the therapist, Sonia began to consider sharing her bisexuality with Roberto and eventually, with the support of the therapist, did so. Roberto initially responded with surprise, and then offered his unconditional love and support to Sonia while agreeing to keep her confidence. As the sibling alliance strengthened, Sonia enlisted Roberto’s help in coping with other family issues. Although she chose not to discuss her sexuality with her parents, Sonia was able to address other concerns with her parents. Subsequently, her mood and grades improved, and Sonia was able to use the therapy to explore her emerging sexuality and to decide when and how to come out to her parents. Families in later life During this stage, families adjust to shifting generational roles. The middle generation may be caring for and supporting the fullest functioning of the older generation, while also benefitting from their wisdom and experience. Tasks for older family members include supporting the middle generation, maintaining their highest level of functioning, cultivating their own interests,

nurturing their couple relationship, coping with the loss of loved ones, partners, siblings, peers, etc., and preparing for death. Because of the advances made by the LGBT civil rights movement, LGBT families in later life may now be constituted in a variety of ways, headed by an LGBT single adult, couple, or multiple partners with or without LGBT or heterosexual children, or may be headed by a heterosexual single person, couple, or multiple partners with LGBT children or adult children (Blando, 2012). There may be variation in tasks, challenges, and benefits depending on type of family formation. Individuals, who come out after raising families or coupling, will have to contend with the responses of partners, adult children, grandchildren, and families of origin, as they work to integrate the new found identity into a life that has been lived longer (Blando, 2012). Individuals who come out later in life may also experience additional oppression in the form of ageism (Blando, 2012). However, they may find the process less stressful, as they are often wiser, more experienced, better resourced, more financially stable, and more independent than those who come out earlier in life (Blando, 2012). Older adults who are less financially independent, or whose health is failing, may face similar challenges as adolescents when disclosing because of their dependence on family support. Prior to the contemporary LGBT civil rights movement and the depathologizing of sexual and gender nonconformance, it was riskier and dangerous to disclose an LGBT identity to anyone. Thus, prior to the 1969 Stonewall rebellion, individuals were less likely to live as out LGBT individuals and more likely to lead double lives. Some LGBT individuals, who came out to their families, found acceptance (Herdt & Beeler, 1998), while others were rejected or chose to disconnect from their families in order to live more authentically. In situations involving cutoffs, the family of choice may have emerged as more salient and relevant. The family of choice may have been established over the life course, thereby playing a significant role in providing material or emotional support (Friend, 1991; Kehoe, 1989; Kimmel & Sang, 1995; Reid 1995; Tully, 1989). Thus, among LGBT people, the tasks and processes of later life may occur in the context of the families of choice, either in addition to or in place of families of origin. Many LGBT individuals will assume the tasks of the elder generation, such as forming adult relationships with adult children, grandparenting, and focusing on their relationships with partners with ease, while others will contend with disapproval and rejection. Some assume the roles of mentors and elders in their families of choice and in return receive needed care. In LGBT-headed families, by this stage, the sexual or gender identity may be a nonissue, as the younger generations have been raised in this context. As LGBT couples and individuals grow older, they may require care or assistance from their own children, siblings, or other family of origin members. If there have been cutoffs in family of origin relationships, old conflicts may resurface causing older LGBT adults to seek out families of choice for assistance. If the family of origin never recognized a partner, children, or family of choice, they may become concerned that the older LGBT relative may be isolated and not have a community to care for them. As LGBT couples age, they may also contend with illness and the loss of a partner and face challenges from systems of care that do not accommodate same-sex couples or invisiblize the sexuality of elders (Giammattei & Green, 2012). If families of origin or creation did not accept the

relationships, there may be a lack of support in obtaining care, for grieving, and rebuilding life as bereft partners. Finally, if wills and other legal documents were not created, a partner may be denied the right to make health care and other end-of-life decisions, or the right to claim their partner’s belongings or shared property. During later life, LGBT adults and their families have the opportunity to act as models for disclosure, living authentically, and thriving and surviving in the face of oppression for younger generations of LGBT individuals and families. Older adults may also act as mentors, parents, grandparents, etc., to members of their families of creation and their families of choice. Case Illustration Janice and Marva Janice and Marva met while working together as nurses. They were both married to men and were raising young families. Although they were already best friends, when Marva’s husband died suddenly, the friendship between her and Janice deepened and the two families became inseparable. As time passed, Janice and Marva grew to understand their relationship as more than friendship. They were soul mates who were deeply in love with one another. However, because they feared that their children would reject them, and Janice did not want to hurt her husband, they continued to represent themselves as friends over the next 20 years. When Marva’s adult children moved out of state, she went with them to be closer to her grandchildren. Janice could not tolerate the separation, so she divorced her husband and relocated to be near Marva. Marva and Janice created a life together without formally coming out to their families. Their adult children and their grandchildren liked and respected both of them and viewed each woman as their “other” mother/grandmother. This living arrangement worked until Marva became gravely ill. When Marva’s adult children attempted to exclude Janice from participating in health care and other decisions about Marva’s future, the two women disclosed the full nature of their relationship to their families. Both families were distressed. Janice’s family distanced themselves and blamed the relationship with Marva for their parent’s divorce. After initial upset, Marva’s family came to accept and respect Marva and Janice as a couple and helped them establish legal documents to protect their rights as a couple. Janice and Marva’s children cared for Marva together until her death 5 years later. Conclusion LGBT individuals have always been members of families and always will be. The commitment to family bonds and lasting relationships is evidenced by the fierceness, innovativeness, and creativity with which LGBT individuals create and expand their families. The United States is slowly recognizing and legitimizing LGBT families and creating structures that will nurture their survival, but there is still a long way to go before all LGBT-headed families are afforded the rights and benefits that are identical to those granted to heterosexual-headed families. LGBT individuals and their families face many of the same life cycle processes and tasks as dominant culture families and draw from their experiences as multicultural people to transact these processes and complete these tasks. The additional tasks and challenges that emerge for LGBT individuals and their families do not emerge because there is something wrong with being LGBT. They emerge because of heterosexism, homo-, bi-, and transphobia, rigid adherence to a biologically determined binary gender system, and the interactive effects of multiple forms of subjugation. LGBT individuals and their families are resourceful in negotiating these additional tasks and often turn challenges into opportunities for self-determination. We must focus on the

unique aspects of LGBT families and the diversity of the many family forms that exist globally to promote the well-being of LGBT families, and to expand our understanding (Giammattei & Green, 2012; Lev & Sennott, 2012; Moore & Brainer, 2012).