Module 4: Week 4: Sexual Orientation
Overview
This module will consider various sexual orientations. The orientation covered will include the
lesbian, gay, bisexual, and transsexual populations.
Learning Outcomes
Upon successful completion of this module, you will be able to:
Distinguish how diverse sexual orientation lifestyle perspectives and identity
development processes impact a client’s life.
Synthesize various counselor roles in eliminating biases, prejudices, and processes of
intentional and unintentional oppression and discrimination into a professional practice
framework.
Consider a biblical/theological perspective that promotes appreciation of diversity while
maintaining a distinctively Christian viewpoint.
Chapter 6: Sexual and Affectional Orientation and Heterosexism
I. Learning Objectives
a. 6.1 Define and distinguish relevant terms and constructs associated with sexual
and affectional orientations.
b. 6.2 Articulate how sexual and affectional orientations intersect with race,
ethnicity, gender, age, education, social class, spirituality, and relationship status.
c. 6.3 Critically evaluate the mental, physical, and social impact of heterosexism on
L G B T Q+ individuals and communities.
d. 6.4 Articulate advances in L G B T Q+ research that can be applied to counseling
practice.
e. 6.5 Apply professional counseling competencies that promote a socially just,
nonheterosexist society to counseling practice.
II. Defining Sexual Orientation and Heterosexism
a. Sexual identity includes:
i. Physical Identity—biological sex
ii. Gender Identity—belief a person has about his/her gender
iii. Social Sex Role Identity—gender roles people adopt based on cultural
norms for masculine and feminine behavior
iv. Sexual Orientation Identity—a person’s sexual and emotional attraction
to members of the other and/or same sex
b. Sexual Orientation—a set of seven variables
i. Sexual behaviors
ii. Emotions
iii. Sexual fantasies
iv. Sexual attractions
v. Social preference
vi. Living life as a heterosexual, bisexual, or gay or lesbian
vii. Self-identification
c. Heterosexuality—romantic or sexual attraction to members of the opposite
gender, most common
d. Homosexuality—individual or group of people who have same-sex feelings and
behavior; no longer preferred term
i. Gay and lesbian are acceptable terms
e. Bisexuality—romantic or sexual attraction to members of either the same or
opposite gender
f. Questioning—an individual who is questioning one’s sexual orientation and/or
gender identity
i. Queer—broad term including anyone who does not identity as
heterosexual; many younger people use Q
g. Pansexual—an individual whose sexual and/or affectional attractions are not
limited based on gender identity or biological sex
h. Heteroflexible—someone who identifies as primarily heterosexual, but may
engage in limited situational same-sex sexual behavior yet not identify as bisexual
i. Affectional Orientation—suggested term to describe sexual minorities (i.e., L G
B individuals) because it broadens discussion beyond sexual attraction
III. Heterosexism
a. Heterosexism—the oppression of L G B T Q+ individuals
b. Internalized heterosexism—internalization of society’s negative attitudes toward
nonheterosexuals
c. Homophobia—fear and hatred of L G B T Q+ people
i. Hate crimes
ii. Recommend using the term homonegativity
d. Heterosexual privilege—unearned advantages due to heterosexual orientation.
i. right to marry
ii. access to medical information in the event of an emergency
iii. legal and financial rights to property
iv. adoptive and child rights
v. validation by the media and culture
vi. being able to arrange to be in the company of other heterosexual people in
most environments
IV. Historical Resistance to Heterosexism
a. Stonewall Rebellion
b. Resistance led by working-class, transgender people of color ignited the gay and
lesbian rights movement
c. Important for counselors to know and teach L G B T Q+ clients about the
historical events of liberation movements
d. Normalize for clients the fact that throughout history L G B T Q+ +have been
oppressed
V. Intersections to Heterosexism and Sexism
a. Some assert that heterosexism is a “weapon” of sexism because it functions to
narrowly define gender roles and enforce compulsory heterosexuality
b. Shared enforcement through socialization practices
c. Derogatory language (e.g., faggot, sissy) that is used with a boy steps outside
traditional male gender norms
VI. Intersections to Heterosexism and Classism
a. Despite higher levels of education, home ownership is lower for partners who are
lesbians and gays than married heterosexual couples
i. Many states have laws that prohibit unmarried couples from owning a
home together
b. Many L G B T Q+ individuals live in metropolitan areas with greater tolerance
c. Working-class gay men may not have the resources to move to higher-amenity
gay neighborhoods, resulting in individuals “remaining in the closet” or living in
nonaccepting areas
i. Increased likelihood for psychological distress and physical violence
VII. Current Attitudes
a. Homosexuality was listed as a mental disorder by the American Psychiatric
Association (A P A) prior to 1973
b. L G B people are not protected from employment discrimination in most states
and communities because sexual orientation is not included in the Federal Title
VII of the Civil Rights Act of 1964, which prohibits job discrimination for other
minority groups
c. Recent polls show 93% of Americans believe that L G B T Q+ people should have
equal employment opportunities, 83% believe same-sex intimate relationships
should be legal, and 72% of Americans accept L G B T Q+ people
VIII. Lesbian, Gay, Bisexual Demography
a. Statistics do not include individuals who may be uncomfortable disclosing an L G
B T Q+ identity, who have not yet realized they are L G B T Q+, and
heterosexually married individuals who may identify as L G B T Q+
b. 2011–2013 survey for the National Center for Health Statistics including 9,175
Americans aged 15 to 44 years:
i. 6.2% of men and 17.4% of women had same-sex sexual experience by age
44
ii. 1.3% of women identified as lesbian and 5.5% as bisexual
iii. 2% of males identified as gay and 2% as bisexual
c. It is estimated that there are 13 million L G BT individuals in the United States,
which represents 4.4% of the population
IX. LGBTQ+ Relationship Status and Family Issues
a. An estimated 980,276 same-sex couples live in the United States
b. L G B T Q+ couples are increasingly choosing to expand their families with over
one-quarter of same-sex couples raising children
c. Lesbian and gay parents are at least equal to heterosexual parents in terms of their
mental health, parenting skills, and quality of family relationships
d. Research has consistently shown that children of gay and lesbian parents are no
different than other children in terms of gender identity development, gender role
behavior, sexual orientation, psychological and cognitive development, social
relationships, and familial relationships
X. Educational Status
a. Higher educational levels than their heterosexual counterparts, however:
i. An estimated 60% of L G B individuals do not have college degrees
ii. L G B individuals are just as likely to live in poverty as heterosexual
individuals and less likely to be thriving financially
1. Possibly due to lack of protection against employment
discrimination and lack of family support
XI. LGBTQ+ Youth
a. 68.7% of middle and high school students reported experiencing verbal
harassment, 25.7% reported physical harassment, 11% reported physical assault,
and 44.9% reported being harassed via text or social media
b. The gay adolescent often exists in social, emotional, and informational isolation
i. Advocacy efforts
ii. Equal Access Act
iii. Gay–Straight alliances
iv. Title IX
c. Must navigate challenges of this period of development like other youth, but may
lack needed coping strategies and support from family, teachers, and adult role
models
d. Sexual minority children and youth are more likely to be sexually abused or to be
abused by a parent
e. Many attempt to escape and self-medicate by abusing substances—L G B youth
use substances 3x more often
f. L G B T Q + students who experience heterosexism and homophobia often report
distress well into adulthood
g. Many L G B T Q + students drop out of school and may end up on the streets
XII. Age and Disclosure of Sexual Orientation
a. Lesbians and gay males in the United States have mean ages in the early 40s
b. Counselors should take into consideration a client’s emotional age and
chronological age
c. Common for individuals who come out as L G B T Q + in adulthood to
experience a late adolescence
d. Average age a person comes out to others is about 25 years
e. L G B individuals are more likely to come out to their mothers
f. Of those who choose to come out, 10% to 15% are rejected by their parents
XIII. Cultural Intersections of Sexual Orientation
a. Issue of multiple oppressed statuses and several identity development tasks
simultaneously
b. Morales (1989) hypothesized an overall model to apply to minorities within the
gay community.
i. Stages: 1) Denial of conflicts, 2) Labeling of self as bisexual rather than
gay, 3) Conflicts in allegiances between gay and minority communities, 4)
Establishing priorities in allegiance, and 5) Integrating various identities
c. Considerations by racial/ethnic group
XIV. Spirituality Among Individuals Who Are LGBTQ
a. Over three-quarters of individuals who are L G B participate in religious
organizations
b. Many queer individuals grow up in churches, mosques, or synagogues that abuse
them
i. Abuse = when a religious group uses coercion, threats, rejection,
condemnation, or manipulation to force submission to religious views of
sexuality
ii. Consequences include self-loathing, loss of close relationships, poor body
image, depression, and suicide
iii. May result in rejecting their L G B T Q identities, leaving religion, or
integrating seemingly opposing identities
XV. Addressing Values Conflicts
a. Be aware of your own biases and serve clients with care and respect
b. A C A Code of Ethics (2014) provides clear guidance on mandate for counselors
not to discriminate based on sexual orientation or gender identity
c. Ward versus Wilbanks affirms A C A’s position that counseling cannot be denied
to a client based on sexual orientation and clients cannot be referred due to a
value conflict
d. Seek training and supervision for ethical practice
XVI. Mental Health Consequences of Heterosexism
a. Historically, many mental health providers have attributed mental health problems
to L G B T Q++ clients without considering environmental factors affecting
mental well-being (attribution bias)
b. L G B T Q + individuals seek counseling more often than heterosexual
counterparts
i. Stereotypes foster self-defeating behaviors, self-persecution, and increased
psychological distress
ii. Result of heterosexism and homonegativism
iii. L G B T individuals are more likely to experience depression, suicide,
anxiety, and substance use disorders
XVII. Suicidality and Depression
a. L G B T Q + individuals:
i. Report disproportionately higher numbers of suicidal thoughts and past
suicide attempts
ii. Are 7x more likely to attempt suicide and are overrepresented in the
number of completed suicides
b. Suicide attempts more likely during developmental milestones associated with
coming out (i.e., first recognition of same-sex attraction)
c. Receiving mental health or medical treatment did not prevent suicide attempts
d. Bisexual individuals often experience discrimination and intolerance from both
heterosexual and gay communities
e. The risk for depression and suicidal behavior is exacerbated for people who are L
G B T Q + and of color
XVIII. Stress and Self-Esteem
a. Minority Stress—stress associated with being a member of an oppressed group
b. Three main sources:
i. Chronic or acute outward events or conditions
ii. Expectation of discriminatory events and the anticipatory energy this
requires
iii. Internalizing society’s negative attitudes and feelings toward individuals
who are L G B T Q +
c. Internalized homophobia negatively affects self-esteem
XIX. Physical Consequences of Heterosexism
a. Substance use
b. HIV/AIDS
XX. Social Consequences of Heterosexism
a. Negative stereotypes
b. Socioeconomic Status
i. Invisibility of poverty among L G B T Q + individuals
ii. Openly gay men make less than heterosexual men with similar
backgrounds
iii. Many L G B T Q + individuals cannot afford to live in high-amenity
metropolitan areas that are more tolerant
iv. Homeless youth
c. Institutional heterosexism
i. Anti-gay marriage laws
ii. Diminished interpersonal relationships
XXI. Counseling Strategies for Addressing Heterosexism
a. Both A C A and A P A passed resolutions opposing prior conceptions that people
who are L G B have mental disorders and created ethical guidelines for their
treatment
b. Reparative/Conversion Therapy—psychological attempts to repair or convert
individuals from L G B to heterosexual
i. Current umbrella term—sexual orientation change efforts (S O C E);
banned by federal courts for use on minors
ii. Detrimental consequences and side effects including depression, anxiety,
intimacy avoidance, sexual dysfunction, internalized heterosexism, and
suicidality
XXII. LGB Affirmative Counseling
a. L G B affirmative counseling involves working with L G B clients to minimize
feeling stigmatized, validating a client’s L G B identity, acknowledging and
processing the influence of oppression, and facilitating a sense of self-pride
b. Counselors should:
i. Be aware of their own strengths and weaknesses working with L G B
clients
ii. Be able to use a variety of counseling interventions
iii. Counter the negative societal messages internalized by L G B clients
iv. Affirm L G B identities
v. Not pathologize same-sex behaviors and affection
vi. Understand issues affecting L G B individuals
XXIII. ALGBTIC Competencies and Counselor Training
a. The Association for Lesbian, Gay, Bisexual, and Transgender Issues in
Counseling (A L G B T I C), a division of the American Counseling Association
(A C A) now known as the Society of Sexual, Affectional, Intersex, and Gender
Expansive Identities (S A I G E), developed competencies to promote sound and
professional counseling practice
b. Counselors should:
i. engage in self-exploration
ii. explore resources that deal with queer and feminist theories
iii. emphasize nontraditional approaches to therapy
iv. become familiar with the constructs of discourse, positioning, and
deconstruction
XXIV. Clinical Practice
a. Counselors should:
i. be aware of their attitudes and beliefs about women and L G B T Q +
individuals
ii. educate themselves and become culturally competent
iii. explore client and counselor meanings of gender identity and sexual
orientation
iv. critically examine the counseling process and theories used with L G B T
Q + individuals
v. examine the power behind the language they use with L G B T Q + clients
vi. expand the meaning of the word “family”
vii. not assume that the client’s presenting problem is related to their gender or
sexual orientation
viii. collaborate with clients to explore how heterosexism permeates the
contextual environments of the clients and what this affects
ix. assess for experiences of discrimination, prejudice, harassment, and
violence in relation to sexual orientation and gender
x. implement the A C A Advocacy Competencies
XXV. Creating a Socially Just, Nonheterosexist Society
a. Counselors should:
i. lobby and support policy change
ii. give back to the community and schools
iii. collaborate with other fields
The Lesbian & Gay Population
I. The Lesbian & Gay Population I
a. 2 – 7% of population
i. Questionable methodologies for 10% claim
b. Hate crimes
c. Church ostracon severe compared to other areas
i. The need for church repentance
II. The Lesbian & Gay Population II
a. Homophobia
b. High student suicide rate
c. High risk of HIV
d. Heterosexism & psychological disorder prevalence disparity
i. Other factors are also involved
III. The Lesbian & Gay Population III
a. Common Issues
i. Losses
ii. Identity issues
iii. Coming out
IV. Sexual Attraction Interpretation Issues
a. Continuum of feelings common
i. Not 100% heterosexual or 100% lesbian/gay
ii. Do occasional thoughts/feelings = gay identity?
b. Importance of accurate sex education information
c. Human sexuality course
V. Gay Identity Development
a. Recognize Cass (1979) and Troiden’s (1979) names as lead researchers
i. Similar themes of feeling awareness, confusion, leading to gay identity
ii. Limitations
1. Only one outcome (gay identity) deemed healthy
VI. Diversity Ethical Issues I
a. APA more open to the role of religious faith & identity in treatment
i. APA Taskforce on Sexual Orientation & Therapy
1. “some individuals choose to live their lives in accordance with
personal or religious values (e.g., telic congruence)
VII. Diversity Ethical Issues II
a. ACA & AAMFT: More unclear on their stances regarding the role of importance
of religious identity in some cases
b. Gay affirmative treatment appears more universally advocated, but the debate
continues
c. Religion a legitimate area of diversity
d. ACA, AMFT & APA Ethical Guidelines
i. Respect for client’s religious faith
ii. Do not impose your values on your clients
e. Religious & sexual identity are both valid areas of consideration
f. Are ACA & nAAMFT’s current recommendations tantamount to values
imposition?
g. Are ACA & AMFT current recommendations unethical when working with
conservative Muslims, Orthodox Jews, and evangelical Christians?
VIII. Diversity Ethical Issues III
a. Is sexual orientation is unchangeable?
i. Statements by APA,ACA
ii. Can randomized control group studies ever be done in this politically
correct environment?
b. Isn’t it all just biological?
i. Genetics studies challenge this assertion
IX. Diversity Ethical Issues IV
a. Are there treatment options other than lesbian/gay affirmative therapy, if a client
desires them?
i. Not imposed must be freely chosen
ii. Narrative sexual identity therapy
iii. Reparative therapy
1. Joseph Nicolosi
2. National Association of Research and Therapy of Homosexuality
iv. Christian ministries
v. Celibacy, sexual identity management approaches
