Lesbians, gay men and family therapy: a contradiction in terms

Lesbians, gay men and family therapy:a contradiction in terms?

Maeve Malleya and Fiona Taskerb

This paper seeks to review the history of discussions about lesbian and gaymale sexuality in family therapy theory and practice. It examines whetherhomophobic and heterosexist attitudes are present in family therapythinking. Possible connections are explored between attitudes towardslesbian and gay issues and the professional backgrounds of family thera-pists, wider debates on homosexuality within society, and conceptualiza-tions of the family life cycle. The question of why relatively little has beenwritten on the issues raised by lesbians, bisexuals and gay men in therapyis discussed. The implications of this oversight on practice are addressedand suggestions made for future work.

In recent years there has been an adjustment within family therapytheory and practice to incorporate a diversity of family forms withinthe concept of family. However, family therapy in general has beenslow to consider sexuality as an influence on family life, and inparticular to address the issues raised by families led by a lesbian orgay parent or a lesbian or gay couple. Much more work has beendone on considering factors such as divorce, gender and ethnicity,both that of our clients and of ourselves as therapists (see, amongothers, Carter and McGoldrick, 1989; Goldner, 1985, 1988; Lau,1984; McGoldrick et al., 1982; Walters et al., 1988) but much lessattention has been paid to sexuality, the topic of this paper. Itshould be made clear at this point that we are not discussing sexualactivity within relationships, a territory reviewed by family therapistssuch as Skynner (1976), but what is often described as sexual orien-tation.

It is, of course, entirely appropriate that ethnicity and gendershould be a focus of attention in order to fully engage with thecultural perspectives that influence the family, but attention also

1999 The Association for Family Therapy and Systemic Practice

The Association for Family Therapy 1999. Published by Blackwell Publishers, 108 CowleyRoad, Oxford, OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA.Journal of Family Therapy (1999) 21: 3–290163–4445

a Assistant Director, Alcohol East, Capital House, 134–138 Romford Road,Stratford, London E15 4LD, UK.

b Lecturer in Psychology, Birkbeck College, London, UK.

needs to be paid to how family therapists (be they heterosexual,bisexual, lesbian or gay male) might need to adapt or expand theirthinking and their practice in order to work with lesbians, bisexualsand gay men. In terms of thinking about issues of power and differ-ence and in incorporating these ideas into family therapy trainingand the provision of service, sexuality as a specific has only recentlybeen identified as a valid focus within family therapy training andhas received limited coverage. Very little work has been done infamily therapy in considering the various family forms of lesbians,bisexuals and gay men, and there seems to be little general movetowards thinking of these different kinship networks as ‘family’.

This paper will consider whether this lack of attention may beinfluenced by the thinking on lesbian and gay male sexuality thatmay pervade the disciplines from which family therapists are drawnand the absence of a substantial body of work published in thefamily therapy literature, which might help to challenge unques-tioned or unthinking attitudes in this area. It will seek to examinethe implications on family therapy practice, of this lack, and to indi-cate in general terms how this could be usefully addressed.

Definitions and terminology

It is important to define the terms ‘homophobia’ and ‘heterosex-ism’, since even a cursory reading of work done in this area indi-cates that these terms are used extensively. It is also necessary to beclear about the terms ‘lesbian’ and ‘gay man’ in this context.

In his often-cited publication, Society and the Healthy Homosexual,Weinberg (1972) defines homophobia as ‘the irrational dread andloathing of homosexuality and homosexual people’. Herek (1986)gives us a definition of heterosexism as ‘a world-view, a value-systemthat prizes heterosexuality, assumes it is the only manifestation oflove and sexuality and devalues homosexuality and all that is notheterosexual’. So, within these definitions, both homophobia andheterosexism can be both personal and institutional, and can leadto individual and societal discrimination, prejudice and violence(Herek, 1989).

As to the terms ‘lesbian’ and ‘gay man’, as they are being usedhere, they refer to women and men who identify as lesbian or as agay male. In defining the proportion of the population who arelesbians or gay men, there has rarely been a differentiation betweenthe incidence of people who are (1) sexually attracted to members

4 Maeve Malley and Fiona Tasker


of their own gender, (2) have, or have had, sex with members oftheir own gender, (3) identify themselves as a lesbian or a gay man,whether or not they have had a sexual relationship with a memberof their own gender (the main refinements of the unidimensionalKinsey Scale suggested by Richardson (1983) and Klein (1990)). Aconsideration of those who identify as bisexual are in respect oftheir lesbian or gay interests similar to those who identify as lesbiansor gay men, although there are obviously important differences(see Fox (1995) for a useful discussion of the issues surroundingbisexuality). This paper does not attempt to discuss bisexuality as aspecific, nor does it assume that the issues are the same as those oflesbians and gay men.

As many commentators have noted, terms such as ‘lesbian’ and‘gay man’ do not simply define sexual behaviour, which is why theterm ‘sexuality’ is used throughout this paper, rather than the morelimited ‘sexual orientation’. Sexuality may influence emotional,psychological, social, familial and spiritual lives, as well as sexuallives (Blumenfeld and Raymond, 1988; Falco, 1991; Imber-Black,1993; Murphy, 1991). The degree of influence that sexuality hasdepends on the degree to which a lesbian or a gay man viewsher/his sexual orientation positively or negatively. However, an indi-vidual who openly defines as a lesbian or gay man will often find that this identification affects every aspect of their lives andrelationships.

There is a need to continually differentiate ‘lesbians’ from ‘gaymen’ by using the separate terms, rather than using the overarch-ing term ‘gay’. Even here there is a generalization involved withthese terms – as though implying that lesbians and gay men formedhomogenous groups. The generalization is compounded andbecomes particularly inaccurate when looking at these two groupsin the context of family therapy, where gender may be a particularlydefining characteristic.

Going back to the question of incidence in the general popula-tion, there have been various estimates based on various studies.The consensus view is, based on Kinsey et al.’s ground-breaking stud-ies in the 1940s and 1950s and supported by more recent data, thatthe figure of one in ten of the population is the best estimate (Belland Weinberg, 1978; Crooks and Baur, 1990; Kinsey et al., 1948,1953) though the British National Survey of Sexual Attitudes andLifestyles gave figures of only 6.1% of men and 3.4% of womenreporting some homosexual experience (Wellings et al., 1994).

Lesbians, gay men and family therapy 5


Estimates of homosexuality from the United States range from 4%to 17% of the population (Gonsiorek and Weinrich, 1991). Giventhe understandable reluctance of many men and women toacknowledge stigmatized sexual experiences and consequentunder-reporting, the debate about incidence in the general popu-lation is likely to continue to be unresolved. Notwithstanding thispoint, a substantial minority of clients in family therapy will identifyas lesbian, gay or bisexual and a greater number will have had ahomosexual experience, with varying implications for their familyrelationships.

Family therapy literature on lesbians and gay men

A search of family therapy publications for papers on sexuality willnot glean a particularly rich harvest. Clark and Serovich’s (1997)content analysis of articles published in seventeen journals in themarriage and family therapy area from 1975 to 1995 revealed thatonly 77 articles out of the 13,200-plus articles considered focusedon lesbian, gay and/or bisexual issues or used sexual orientation asa variable. In particular, there is one paper in the Journal of FamilyTherapy (Ussher, 1991), two from the Journal of Strategic and SystemicTherapies (Crawford, 1988; Rabin, 1992), an early paper from FamilyProcess (Krestan and Bepko, 1980), one paper from the FamilyTherapy Collections (Collins and Zimmerman, 1983), three from aspecial edition of the Networker (Dahlheimer and Feigal, 1991;Markowitz, 1991) and, more recently, one from Context (Hardman,1995), and two from the Dulwich Centre Newsletter (Hewson, 1993;Stacy, 1993). There is also an extremely useful paper in the Journalof Marital and Family Therapy, which discusses, in the context offamily therapists’ work with clients and families affected by HIV andAIDS, family therapists’ work with, and attitudes towards, lesbiansand gay men (Green and Bobele, 1994). The latter paper discussesthe ‘silence in the field’ (of family therapy) regarding sexuality ingeneral, a contention supported by even a cursory search of familytherapy journals in the last decade.

There are also relatively few papers in journals which are notspecifically family therapy journals, though American authors seemto have been much more active in this field than British or otherEnglish-speaking authors (Milton and Coyle, 1998). The papersthat there are (DiBella, 1979; MacKinnon and Miller, 1985; Roth,1985; Rothberg and Ubell, 1985; Ryder, 1985; Shernoff, 1984;



Weinstein, 1992), are cited again and again in the relevant litera-ture – an indication of the lack of other work in the field.

Influences on family therapists’ attitudes towards lesbians and gay men

What other sources of information on sexuality will family therapistsconsider when working with lesbian and gay clients? It seems rele-vant to review attitudes prevalent in the professions in which manyfamily therapists trained, and to consider the perspectives fromwhich much of family therapy thinking was derived. Finally, it isappropriate to examine the wider context of beliefs about sexualityheld in society.

Health professionals’ attitudes toward lesbians and gay men

Although there has been very little written by, or for, family thera-pists about working with lesbians, bisexuals and gay men, there hasbeen some work done, predominantly in America, on healthcareprofessionals’ attitudes to lesbians and gay men. Peer attitudes, inthe case of family therapists, are liable to be affected by the prevail-ing attitudes debated within the professional body to which theybelong, modified by any training they have done and the contextsin which they have worked since finishing their initial professionaltraining. Since most family therapists fall into the wider group of‘healthcare professionals’ – social workers, nurses, doctors, psychia-trists, psychologists, psychotherapists – it may be illuminating toreview some of the work done with these groups.

Studies have sampled the attitudes towards homosexuality of thefollowing professional groups: social workers (Anderson andHenderson, 1985; Berger, 1983, 1984; Dulaney and Kelly, 1982;Gramick, 1983; Hartman, 1993; Lukes and Land, 1990; Potter andDarty, 1981; Tievsky, 1988; Wisniewski and Toomey, 1987), nurses(Anderson, 1981; Douglas et al., 1985; Eliason et al., 1992; James etal., 1994; Scherer et al., 1991; Taylor and Robertson, 1994), doctors(Bhugra and King, 1989; Douglas et al., 1985; Kelly et al., 1987),psychologists (Annesley and Coyle, 1995; Haldeman, 1994; Miltonand Coyle, 1998) and psychiatrists (Gartrell et al., 1974; Rabin et al.,1986).

Uniformly, all the above studies concluded that homophobic atti-tudes were still present among some health professionals. It seems



unsafe to hypothesize that these attitudes are becoming less preva-lent, since several studies indicate that, post-AIDS, attitudes may, infact, have become more negative than they were previously(Douglas et al., 1985; Kelly et al., 1987; Schwanberg, 1990). Threemore general papers on attitudes towards lesbians and gay menamong healthcare professionals (Schwanberg, 1990), a textualanalysis of attitudes towards lesbian sexuality in the healthcare liter-ature (Stevens, 1992), and a general survey of research on the train-ing given to US mental health professionals (social workers, clinicalpsychologists, counselling psychologists, counsellors) in the area oflesbian and gay male sexuality (Murphy, 1991) came to similarconclusions as the specific studies mentioned above. That is, toquote from Murphy’s paper, ‘despite the large number of clientswith gay and lesbian concerns, many mental health professionalsremain biased and unqualified to serve them’ (Murphy, 1991).

It is not useful to labour the point that homophobia is asendemic in the ‘helping professions’ as it is in society generally.Although individual viewpoints can always be seen as extreme orunrepresentative, it is interesting and perhaps salutary to comparetwo letters printed in professional journals. One, from 1981, is to anAmerican social work journal and one, from mid-1995, is to aBritish psychology journal; both are in response to articlesdiscussing the need for more lesbian and gay male affirmative prac-tices in these respective professions. The first begins, ‘Although Imust admit to an innate bias against homosexuals,’ and goes on, ‘Ihave no doubt that lesbians constitute a minority in the femalepopulation – a fact for which I am thankful both for their sake andfor the sake of the Nation’ (Johnson, 1981). This bears an uncannyresemblance to the following sentiments expressed fifteen yearslater:

I object to the misleading use in a publication of a scientific society of theinnocent-sounding word ‘gay’ when referring to what is the abnormalpractice of anal intercourse between males. Secondly, I object to attemptsto mislead readers about the epidemiological incidence and prevalence ofmale and female homosexuality, which in statistical-mathematical terms isfortunately still tiny.

(Hamilton, 1995)

Hamilton’s letter provoked a swift counter-response among thereadership of The Psychologist and homophobia of this kind is likelyto be confined to the more reactionary fringe. However, there are



heterosexist attitudes of a less glaring kind. These may range froma well-intentioned liberalism which has its own limitations – as wediscuss below – to a simple lack of awareness of the special ‘culturalcontext’ (Crawford, 1988) of many lesbians and gay men.

Psychotherapy and sexuality

Within the field of psychoanalysis, some theory and practice in bothAmerica and Britain has been slow to change its stance on lesbianand gay male sexuality. It was not until 1991 that the AmericanPsychiatric Association agreed to permit lesbian and gay psycho-analysts to join the Association (Blumenfeld and Raymond, 1993).In Britain, a 1994 study by Mary Lynne Ellis of whether Britishpsychoanalytic training organizations would admit lesbians and gaymen as trainees demonstrated a general lack of clarity and anunwillingness to explain criteria for selection. In some instances italso found that lesbians and gay men had been turned down in theadmissions process because of their sexuality (Ellis, 1994).

Furthermore, there is still a relatively high-profile group of prac-titioners who specialize in ‘conversion’ or ‘reparation’ techniques,working particularly with gay men. The assumption behind ‘conver-sion’ or ‘reorientation’ techniques is that homosexuality is a deeplyundesirable state and, while practitioners can justify this practiceunder the heading of simply following their clients’ wishes, evenrecent work by practitioners of this type clearly defines homosexu-ality as an entirely pathological orientation (Nicolosi, 1993). AsMurphy says, ‘there would be no re-orientation techniques wherethere was no view that homoeroticism is an inferior state, an inter-pretation that in many ways continues to be medically defined,criminally enforced, socially sanctioned and religiously justified’(Murphy, 1992).

It is important to note that there are some psychoanalyticallytrained psychotherapists who have written about working withlesbians and gay men in a non-pathologizing way (e.g. Isay, 1989;Lewes, 1988; O’Connor and Ryan, 1993). Furthermore, there aresome indications that the presence of lesbians and gay men in theclient population is being acknowledged in the wider field ofpsychotherapy. The first British book on working with lesbians andgay men in psychotherapy has been published quite recently(Davies and Neal, 1996). Furthermore, two new British organiza-tions for lesbian and gay male counsellors and psychotherapists are



flourishing: the Association for Lesbian, Gay and BisexualPsychotherapists (ALGBP) and the Project for Advice, Counsellingand Education (PACE).

Nevertheless, prejudice in psychoanalytic thought seems to havefiltered down into psychodynamic psychotherapy thinking and intothe psychiatric profession. A review by Denman of psychodynamicliterature on homosexuality supports the view that ‘the prevalenceof prejudices about homosexuality is seen to be especially greatamong psychodynamic therapists’ (Denman, 1993). Until 1973, theAmerican Psychiatric Association categorized homosexuality asmental illness and, though there was a successful campaign in 1973to 1974 to delete this category from the DSM-II, in the followingyear, however, a vigorous campaign was mounted to reverse thisdecision, led by analysts such as Bieber and Socarides – exponentsof ‘conversion’ techniques. Finally, after a referendum of the wholeassociation, the change was upheld, although the category ofegodystonic homosexuality remained classified as psychopathologyuntil 1987 when this category was finally removed from the secondedition of DSM-III (American Psychiatric Association, 1987).However, in DSM-IV there remains a category ‘sexual disorders nototherwise specified’ which includes ‘persistent and marked distressabout sexual orientation’. This corresponds closely to the categoryof ‘egodystonic sexual orientation’ in the World HealthOrganization’s ICD-10 classification of mental and behaviouraldisorders defined as ‘where the sexual preferences (heterosexual,homosexual, bisexual or prepubertal) are not in doubt but the indi-vidual wishes it were different’. Since there is no great incidence ofindividuals in this society who identify as heterosexual wishing toidentify as homosexual, this category is rather more likely to beapplicable to lesbians and gay men than to heterosexuals (Sayce,1995).

The American Psychological Association established a committeeon lesbian and gay concerns in 1980. Further to this in 1984,Division 44 was set up within the association, to be devoted to ‘thepsychological study of lesbian and gay issues’ (Greene and Herek,1994). This is in marked contrast to the fact that in 1998 themembership of the equivalent British body, the BritishPsychological Society, is still being balloted as to whether there issufficient support for the formation of a lesbian and gay psychologysection of the society.

Not all family therapists will have been trained as psychiatrists,



psychologists, psychoanalysts or psychodynamic psychotherapists,though a proportion will fall into these groups. Furthermore, manycommentators have noted the psychoanalytic roots of family ther-apy thinking and, since most of the seminal thinkers in early familytherapy were psychoanalytically trained psychiatrists, they wereunlikely to have been free of the influences of their training orien-tations (Barker, 1992; Hoffman, 1981).

The context of liberal humanistic ideology

Family therapists will tend to reflect the prevailing belief structuresand those of their family and peer group (Ryder, 1985). Familialattitudes towards lesbians and gay men will tend to reflect both theviews of the wider societal context and the particular religious, polit-ical, ethnic, cultural and class perspectives of the family as well astransmitted intergenerational family beliefs (Greene, 1994). AsFine and Turner say (1991: 319),

[therapists have] been slow to take an analytical position about how thepolitics from their own clinical work is influenced by dominant beliefsfrom their own cultural system.

Within current white Western society, there are various compet-ing ‘explanations’ of homosexuality that can be divided into thosefalling into ‘essentialist’ and ‘constructionist’ schools (Hart, 1984;Mars-Jones, 1995). Within the essentialist group would come expla-nations based on biology – genetics, hormonal imbalance (Burr,1993) – and early familial environment (psychoanalytic theory, envi-ronmental and behaviourist theories). Constructionist views wouldembrace the idea of ‘choice’ as pre-eminent in sexuality and sexualorientation. Here rigid categorization and definitions of sexualityare seen as societal constructs, rather than as reflecting a reality in‘nature’ (Kitzinger, 1987, 1995). The meaning of a lesbian, gay orbisexual identity for the individual and for others is embodied inthe often-conflicting concepts current within his or her culture,leading to the development of different narratives around sexualidentity development.

There is no clear-cut association between different explanationsof the aetiology of homosexuality and the extent to which lesbian,bisexual and gay sexuality is pathologized (for just one example ofthis see the earlier discussion of the divergent views within thepsychoanalytic movement). One of the most prevalent influences



on thought in white Western culture is liberal humanist philosophywith its emphasis on individualism (Sampson, 1977). Althoughliberal humanism has been influential in opposing the pathologiz-ing of sexual minorities because ‘everyone has equal human rights’,it has been widely confused with the notion that lesbians, bisexualsand gay men are ‘just the same as everyone else’ (Kitzinger, 1987).While those subscribing to these views are likely to hold neutral oreven positive attitudes towards lesbians and gay men, the danger ofthis lack of differentiation is that heterosexual patterns (such asfamily life cycle patterns) will be imposed upon lesbian and gay rela-tionships. Consequently, different ways of relating in same-genderrelationships are at best ignored and at worst discriminated against(Hardman, 1997).

In the therapeutic context the liberal humanistic view hascontributed to the idea that family life cycle models of normativefamily functioning can be generally applied with little modificationto family therapy with lesbians, bisexuals and gay men and theirfamilies. It has also led to expectations that no special knowledge oflesbian, bisexual or gay sexuality is needed and that therapeutictechniques and interventions for working with heterosexual clientscan be simply translated for working with lesbians, bisexuals and gaymen (Brown, 1996). These views have only recently begun to bechallenged within family therapy; for example, the interestingdiscussion between Walker (a female heterosexual therapist) andSiegel (a gay male therapist) of therapeutic practice with lesbianand gay male clients (Siegel and Walker, 1996).

Models of the family life cycle

One of the enduring cornerstones of family therapy theory andpractice, the family life cycle, is often used as a blueprint for moni-toring the family’s progress through family therapy. The most influ-ential family life cycle model developed by Carter and McGoldrick(1980) is a template based on entirely heterosexual assumptionsand milestones. Furthermore, as there is little additional materialavailable on lesbian and gay issues, trainee family therapists aretaught a framework in which to organize family experiences and thedevelopment of the family through time; that is, based on inappro-priate premises when applied to working with lesbian or gay malecouples and families with a lesbian or gay member.

Although it is true to say that Carter and McGoldrick’s revised



model acknowledges lesbian-led families (Carter and McGoldrick,1989), their view of lesbian relationships appears to emphasizepathological patterns without considering the broader context oflesbian and gay relationships. For example, Carter and McGoldrickrely heavily on Krestan and Bepko’s (1980) warning of the dangersof fusion in lesbian relationships (Carter and McGoldrick, 1989:60–61, 218–219). It is suggested that the lack of acknowledgementby both the extended family and wider society of lesbian relation-ships creates difficulties for the lesbian couple, who are thrownback on their own resources to sustain the relationship, thus creat-ing an increasingly closed system.

Studies with non-clinical samples have found little evidence offusion in lesbian relationships and instead suggest that both lesbianand gay couples report more cohesion and flexibility on averagethan do heterosexual couples (Green et al., 1996). Many lesbians,and gay men also, compensate for the lack of acknowledgementfrom extended family and mainstream society by increasingsupportive links with the lesbian and gay community. From theperspective of heterosexual relationships, in which gender roles sooften give each partner individual definition, the absence of genderdifferentiation in lesbian and gay male relationships may makesame-gender couples seem enmeshed. However, from inside thelesbian or gay relationship the close understanding each has of theother may be mutually supportive of identity development, and fitwith the expectation of equality, as well as being protective againstthe hurt that homophobia causes. Paradoxically, the possibilities forcombining friendship and equality with sexual intimacy may makefor both greater understanding of each other’s needs and thepotential for greater trust and individual autonomy. For some same-gender couples this may allow for the development of an open rela-tionship in which other sexual relationships do not jeopardizeemotional intimacy within the primary relationship (Blumstein andSchwartz, 1983; Kitzinger and Coyle, 1995).

Heterosexual values may not simply translate on to lesbian andgay male relationships. While there are many similarities betweenlesbian and gay relationships and heterosexual relationships, it isimportant not to discount the differences (Siegel and Walker,1996).

Gay male relationships receive little attention in Carter andMcGoldrick’s family life cycle model, but are specifically mentionedin the context of a discussion of the impact of AIDS on the family



(Carter and McGoldrick, 1989). HIV and AIDS undeniably haveserious implications for individuals and families, both in terms ofthe stigma attached to the condition and coping with illness withinthe family; nevertheless, HIV and AIDS is not the defining featureof gay relationships. While therapists will need to increase theirknowledge and awareness of the problems arising from sero-positivestatus, it does a disservice both to lesbian, gay male and heterosex-ual couples, families and individuals to assume that these problemswill apply only to gay men.

Heterosexual family formation and parenting forms the corner-stone of Carter and McGoldrick’s family life cycle. According tolarge-scale surveys of lesbian and gay communities, about one infive lesbians and about one in ten gay men are parents (Bell andWeinberg, 1978; Bryant and Demian, 1994). However, parenting forlesbians and gay men does not take place in the same context as itdoes within heterosexual relationships. For instance, it has beenestimated that between 2 and 4% of married men have also had asame-gender sexual relationship at one or more points during theirmarriage (Ross, 1990) and an unknown number of married womenhave had sexual relationships with other women (Coleman, 1990).Currently it seems likely that the largest number of lesbian and gayparents are parenting after the ending of previous heterosexualrelationships (Patterson, 1995). Therefore, many lesbians and gaymen are non-residential parents, single parents or are parenting instepfamily situations (for discussion of these issues as they relate toadults and children in lesbian and gay families see Bozett, 1987;Patterson, 1995; Tasker and Golombok, 1997).

If a lesbian couple does plan parenthood together through donorinsemination then decisions have to be made about whether to use ananonymous or a known donor, and about which of the prospectivemothers will be biologically related to the child (Martin, 1993; Saffron,1994). Gay men and lesbian women also become parents throughsurrogacy arrangements, fostering and adoption, although there aremany restrictions to overcome (Martin, 1993). Finally, many lesbiansand gay men are involved in co-parenting children who do not livewith them all the time. While many lesbian and gay couples cohabitthis is less common than heterosexual cohabitation or marriage(Kitzinger and Coyle, 1995), and often ex-partners may continue to beinvolved in children’s lives. A child growing up in a family headed bya single lesbian or gay parent or couple may well have more than twocarers, and this needs to be appreciated in family therapy.



Models of the lesbian or gay family life cycle

A family life cycle approach that locates current difficulties as aperiod of transition can be of considerable help in therapy. Thefamily life cycle model of Carter and McGoldrick (1989) alsodraws attention to the intergenerational perspective important tomany considerations within the immediate household, and ithighlights the extent to which the family is embedded within theextended family and wider social systems. Consequently, it is worthconsidering alternatives to the heterosexual family life cycleoutlined by Carter and McGoldrick. One commendable recentattempt has been made to articulate a lesbian family life cycle(Slater, 1995). Slater proposes a five-stage model of the family lifecycle for lesbian couples based on developmental changes in thequality of the couple’s relationship. The model is not focusedaround reproductive events, although it can incorporate the tran-sition to parenting if that is appropriate for the couple. The modelbegins with the formation of the couple relationship, emphasizingnot only the excitement involved in partnering, but also indi-vidual fears of vulnerability. Stage two involves establishing anongoing relationship through learning how to manage both simi-larities and differences in the relationship. Commitment is thecentral issue of stage three, as the couple begins to make futureplans and to decide whether to make a permanent commitment toeach other. This brings benefits of increased trust and securityinto the relationship, but it also needs to be reconciled with theclosing down of other options. Slater’s fourth stage is focused ongenerativity. Here the couple has established confidence in eachother’s love and together focus on making an enduring contribu-tion in their lives (either through working on joint projectsand/or through sharing in parenthood). The fifth and final stagein the model deals with the issues faced by older couples wherethe couple has to cope with life changes imposed by retirement,the possibility of becoming grandparents, illness and ultimatelythe death of one partner.

One model of how gay male couple relationships develop hasbeen proposed (McWhirter and Mattison, 1984). McWhirter andMattison’s model delineates six stages in the couple relationship:blending, nesting, maintaining, building, releasing, and renewing.Stages one to four are more or less compatible with Slater’s earlystages. However, McWhirter and Mattison add an additional stage of



‘releasing’ before the final stage, where the couple begins to taketheir relationship for granted and appear to be pursuing their ownlives before they are able to renew the relationship.

Both Slater’s and McWhirter and Mattison’s models are useful intherapy, as they highlight issues around the challenges of develop-ing an ongoing same-gender relationship when this is discriminatedagainst by heterosexual culture. There are, however, many difficul-ties in enunciating a family life cycle for lesbian and gay couples,and while many of these are acknowledged in the models outlinedabove, they present significant drawbacks to using these models as‘templates’ for couple and family therapy.

Central to this point is that individuals may be at a different stagein accepting their own sexual identity. Each partner, therefore, mayhave a different idea of how visible they want their lesbian or gayrelationship to be to their family of origin, friends, work colleaguesand the outside world.

Within both lesbian and gay partnerships there is a greater mixof pairings than in heterosexual couples, across ages, across ethnicand religious groups, and across social class (Kitzinger and Coyle,1995). These are all factors that are likely to influence how open anindividual wishes to be about his or her sexual identity. As is typicalfor research in this field, little account is taken of how sexual orien-tation and cultural background, particularly ethnicity, interact inshaping the family life cycle of lesbian and gay relationships in themodels outlined above. As Greene (1994) points out, differentethnic groups and family networks therein may be more or lesssupportive of lesbian, gay or bisexual members and it may be moreor less feasible to be ‘out’ as a lesbian or gay family within particu-lar ethnic groups. On the other hand, experience of dealing withracism may be a useful resource to draw upon in dealing with homo-phobia and heterosexism (Laird, 1996).

Other difficulties exist in setting up lesbian and gay family lifecycle models as prototypes for use in family therapy, particularly asthese models tend to visualize the lesbian or gay male couple onlyin a monogamous, committed, cohabiting relationship which doesnot suit all lifestyles (Kitzinger and Coyle, 1995). Family life cyclemodels tend to reify the couple status and to create their ownnormative agendas, while ignoring the fluidity of many relation-ships (Weeks et al., 1996). Other commentators such as Harry(1988) have suggested that identifying processes within the rela-tionship (for example, conflict, dependence, individuation) may be



more useful than attempting to conceptualize lesbian and gay malerelationships as a series of cumulative stages.

Non-heterosexist family therapy

What should a non-heterosexist family therapy look like? First andforemost, non-heterosexist practice should allow both individualsand families to define themselves. Allowing clients to define theirown families would allow them to include important relationshipsand defining events which may otherwise be missed. One of themain complaints that lesbians and gay men have when facing insti-tutions in society is that they are viewed as individuals and noacknowledgement is given to them as family members.Advertisements for healthcare and therapy depict heterosexualfamilies. Forms ask for marital status. No acknowledgement is givento the partnership rights of individuals in same-gender relation-ships. Men and women who are single are assumed to be unpart-nered – or even looking for a relationship with someone of theopposite gender! Non-heterosexist practice, however, would alwaysconsider that clients could be lesbian, gay, bisexual or heterosexual.

Allowing individuals and families to define themselves may beparticularly difficult when it is an adolescent who expresses an inter-est in a lesbian or gay relationship. For instance, it may be difficultduring family therapy sessions to seek information from an indi-vidual which he or she might not be willing to share with otherfamily members at that point (for example, ‘do you think you mightbe gay?’). In these situations an individual therapy session might beuseful, a practice which is already standard in many adolescentservices. When a daughter or son’s homosexuality is being discussedin family therapy, heterosexual parents may be anxious to convincethe therapist that this is a passing phase for their child, while theyoung person may not be in a powerful enough position to asserther or his own feelings. The therapist will need to work hard tokeep the issue of sexuality open and to prevent foreclosure on thetopic. Therapy may also provide a safe space for family members toclarify any misconceptions about lesbians, gay men or bisexuals andto air resentments about heterosexual agendas not being fulfilled(see Ussher (1991) for further discussion). Many lesbian, gay andbisexual adolescents experience mental health problems associatedwith the stress of trying to conform to heterosexual expectations(Davies, 1996; Tasker, 1996).



Family therapy can create a much needed space in which toexplore the many implications of ‘coming out’: who to come out to,when to tell them, how to tell them. This is not only salient to thelesbian, gay or bisexual client him- or herself, but is also importantfor other family members who will be facing decisions aboutcoming out about their ex-spouse, parent, son or daughter, brotheror sister. Discussing this issue within therapy can help to engendera sense of control over the disclosure, which may otherwise not beachievable.

It would be short-sighted to believe that different types of familytherapy may be more or less suited to working with lesbians or gaymen and their families. Though the trend may have been towards amore ‘integrative’ approach, rather than entirely discrete ‘models’of working, a distinction of approach can still be seen from team toteam and context to context. All approaches may make some usefulcontribution at different points, although clearly there are thosethat, ostensibly, rely less on ‘normative’ models of the family andfamily functioning. For instance, viewing the family through thelens of classic structural family therapy in terms of systems andboundaries may not apply in the same way to families where bothadult members are of the same gender. Nevertheless, structuraltechniques of clarifying relationships in terms of boundaries may beuseful to consider with lesbians or gay men and their families. Forexample, when considering the boundaries of the parental andcouple subsystems, the therapist will need to bear in mind thatadults with parental responsibilities may not all live under the sameroof and may not share an intimate relationship themselves. Manyaspects that apply to family therapy with heterosexual stepfamilieswill be helpful to consider here (for a useful discussion of theseissues see Gorell Barnes, 1991; Gorell Barnes et al., 1997; Robinson,1991). However, other aspects such as the gender subsystems andthe exclusivity of relationships within and outside the family may bedifferent for lesbians and gay men and their families. Clarifyingrelationships in terms of boundaries may also help a lesbian or gayfamily define itself as a family unit when it is not recognized as suchby other people, or when this definition is threatened by main-stream heterosexual society.

Similarly, other traditional systemic models of family therapy mayhave both strengths and weaknesses when working with familieswith lesbian or gay members. Hypotheses as starting points forMilan systemic therapy sessions will need to be carefully thought



through to ensure that they are not dominated by heterosexualfamily scripts, or are in fact rendered unrealistic in the light of thepressures of external prejudice that lesbians or gay men and theirfamilies face. However, the emphasis in the Milan model on helpingfamilies redefine themselves through prescribed rituals could be auseful technique in helping to delineate relationships. Indeed,different authors have already suggested that private and publicrituals may be used as markers in defining the significance of rela-tionships and the responsibilities entailed within them.Furthermore, public rituals may be a key to the recognition of asame-gender relationship within the wider circle of family, friendsand associates (Roth, 1985; Slater, 1995; Slater and Mencher, 1991).Rituals need not be based on heterosexual models, such asmarriage ceremonies. The creativity of much lesbian and gayculture may be a useful asset in helping the family to invent mean-ingful rituals. Powerful as rituals may be in changing interpersonalrelationships, it would obviously be unrealistic to think that they canovercome many of the external pressures faced by same-gendercouples. In particular, lesbians, gay men and bisexuals face legaldifficulties; for example, over the age of consent for gay men and interms of partnership rights and recognition for non-biologicalparents (Hearne and Rights of Women, 1997; Kitzinger and Coyle,1995).

It is possible that the therapeutic techniques with the greatestpotential for working with lesbian, gay and bisexual clients andtheir families come from the social constructionist movement(Laird, 1996). These therapies are derived from hermeneuticphilosophy that there is no objective reality; therefore, the ‘prob-lem’ that the family brings to therapy does not exist independentlyof the system that observes it and gives it meaning through thelanguage that is used to describe it. Consequently, the basic thera-peutic approach is designed to open up other narratives, or differ-ent ways of making sense of the problematic experience. Andersonand Goolishan (1992) outline an open agenda for therapy, propos-ing that the therapist actively cultivates the position of ‘not-knowing’to create a conversational space in which the client’s ‘explanations’generate new meanings for events. Such a stance allows for theprimacy of the client’s experience and understanding. It alsoprecludes the therapist’s preconception of an explanation of events.Nevertheless, this reflexivity is necessarily bound by the limits of thetherapist’s own cultural position. Other more directive postmodern



therapies include narrative therapy (White and Epston, 1990). Hereit is argued that families come into therapy with problem-saturatednarratives that jeopardize identity and self-esteem. In contrast toAnderson and Goolishan’s more open-ended approach, the explicitaim of narrative therapy is to replace problem-saturated stories withnew empowering narratives.

Finding new meanings is particularly important for lesbians, gaymen and bisexuals and their families, because mainstream cultureat best ignores homosexuality or at worst is deeply pathologizing. Toa greater or lesser extent these views will have been absorbed bythese families generating narratives dominated by internalizedhomophobia. Helping families to re-evaluate these explanations intheir cultural context will likely enable them to generate their ownways of dealing with the situation they face. White and Epston’sparticular technique of externalizing the problem (Epston et al.,1992; White, 1988) seems suited to effectively locating the source ofdifficulties arising from homophobia within the external pressuresfacing lesbians, gay men and bisexuals and help families to mobilizetheir resources to overcome outside definition of the problem.Appreciating the family’s view from within the larger social contextin which the family lives will facilitate the fit between the solutionreached and the context it lives in (Cronen and Pearce, 1985).

It is probably most important to be aware that it may be less themodel than the practice of family therapy that defines the ‘useful-ness’ and ‘affirmative’ qualities of the therapeutic encounter. Thetherapist him- or herself and other non-specific factors have beenfound to influence therapeutic outcome more than the particularpsychotherapeutic model used in therapy (Friedlander et al., 1994;Lambert et al., 1986). The underlying beliefs and assumptions oftherapists, as mediated through their training institution, profes-sional background, practice setting and a host of other variables(Malley, 1996), may determine their ability to work with lesbiansand gay men more clearly than the model they use.

Adopting a perspective from second order cybernetics leads toconsideration of the characteristics of the therapist(s) who are join-ing the family system. Therapists could have (or may be seen by oneor more families members as having) a position that is similar ordifferent to the client’s own position in various aspects. Certainlythe therapist’s and client’s awareness of similarities or differences interms of sexuality, gender, ethnicity, (dis)ability, class and upbring-ing may facilitate the exploration of the issues that the family faces.



Matching the therapist’s sexuality with that of the client may help insome instances (especially if the client feels that this is salient).Choosing a therapist may also be an initial step in actively defininga new identity. Although having sexuality in common may facilitaterapport and give a deeper understanding, it would be unwise toassume that matching of itself will necessarily promote this withinthe therapeutic context. Just as there are tremendous differencesbetween heterosexuals, so there are among lesbians, gay men andbisexuals. As Anderson and Goolishan have argued:

therapists are always prejudiced by their own experience but … they mustlisten in such a way that their pre-experience does not close them to thefull meaning of the client’s descriptions of their experience.… To dootherwise is to search for regularities and common meaning that may vali-date the therapist’s theory but invalidate the uniqueness of the client’sstories and thus their very identity.

(Anderson and Goolishan, 1992: 30)

Furthermore, it is important to point out that in many lesbian-and gay-headed families, not all family members share the samesexuality (Allen and Demo, 1995). Consequently, the basic familytherapy approach with a team of therapists of differing sexualitycould be a considerable advantage. Taking this one step further bygiving the family the opportunity to observe different therapistsexchanging views in a reflecting team (see Andersen, 1987, 1992;Davidson, 1988) may also help to provide multiple perspectiveswhich may be more difficult for the individual therapist to achieve.

Training issues

Garnets and colleagues estimate that the average psychotherapistwill see at least one sexual minority client at some point in his or hercareer (Garnets et al., 1991). While those family therapists who haveseen families headed by a lesbian couple or a gay male couple arealmost certainly in a minority, a much greater number will haveseen lesbians or gay men as individuals or as an adolescent or youngadult growing up in a heterosexual family (Malley, 1996). There isalso the fact that many family therapists may have seen lesbians orgay men in one of these contexts without recognizing that they werelesbian or gay.

How effective is family therapy training with respect to workingwith families in this area? In a small-scale questionnaire survey of 50



trainee and qualified family therapists conducted in 1995, fewerthan a quarter of family therapists had spent more than two hoursin their entire family therapy training (a minimum of four years inthose surveyed) specifically addressing issues connected with work-ing with lesbians and gay men (Malley, 1996). Some of thosesurveyed mentioned more general family therapy concepts thatthey had usefully applied to working with this client group, forexample, ‘curiosity’ and an understanding of ‘thinking systemi-cally’. Nevertheless, many identified a great gap in thinking andteaching in this area. In terms of psychotherapy training, Brown(1996) suggests a number of areas which could be improved toprovide a more effective and unbiased service for sexual minoritygroups (including transgendered people): integration of bothresearch and experiential literature relating to lesbian and gayissues into training, supervision of work with lesbian, gay and bisex-ual clients during training, creation of therapeutic models thatwould assist in non-heterosexist practice, and development of clearequality policies in terms of therapeutic goals. These same pointersfor improved practice could usefully be applied to family therapytraining.

Discussion

Family therapy thinking and theory is not a homogenous mass ofknowledge, nor is there a uniform stance or body of thought on theissue of working with lesbians and gay men. However, there hasbeen relatively little written on the issue of sexuality, in markedcontrast to the extensive work done on consideration of gender,ethnicity and family structure in family therapy. The lack of interestalso presumably helps to explain why so little research investigatesthe various forms of ‘family’ experienced by lesbians and gay menand the kinds of family therapy that may be most appropriate tooffer to this client group.

A consideration of the professional backgrounds of family thera-pists and the genesis of family therapy thinking seems to suggestthat family therapists, in many cases, will be unsupported in theirwork with lesbian, bisexual and gay clients and their families.However, more generally it is likely that many therapists have littleknowledge and training in this field, and are left unaided by tradi-tional family life cycle models.

It is possible to identify within various therapeutic approaches



outlined in this paper several interventions and ways of workingthat may assist therapists in working with lesbian and gay clients andtheir families. Family therapy has been quicker than manypsychotherapeutic orientations to address, or acknowledge, issuesrelated to difference, context and the non-objectivity of the thera-peutic view, and so it is well placed to begin to further expandperspectives on sexuality as part of this reflexive vision.

Acknowledgement

The views expressed in this paper are our own. However, we wouldlike to thank David Jones for his helpful comments on earlierdrafts.

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Lesbians, gay men and family therapy: a contradiction in terms

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