Safety Issues, Acceptance, and Outcomes
This chapter takes a look at what clinicians and educators can do to support the families of LGBTQ+ youth. It includes offering safety for parental reactions of grief, loss, disappointment, resistance, fear, aversion, worry, and sparing youth from these reactions. Engaging activities are offered to help clinicians and educators assess and explore the family’s readiness to support LGBTQ+ youth. The importance of parental support in long-term outcomes for LGBTQ+ youth frames the practices, activities, and worksheets contained in this chapter.
PARENTAL ACCEPTANCE AND SUPPORT
LEARN
Family acceptance of LGBTQ+ youth has been demonstrated as the greatest protective factor against negative physical and mental health outcomes (Ryan et al., 2009). Researchers found that high family rejection is associated with LGB, and some T, youth being:
• 8.4x more likely to have attempted suicide
• 5.9x more likely to report high levels of depression
• 3.4x more likely to use illegal drugs
• 3.4x more likely to be at high risk for HIV and STDs
“Latino males retrospectively reported experiencing the highest levels of rejection for their sexual orientation during the teen years.”
It’s important to confront families with this information and data. (Several pages of facts and statistics are included in Appendix B for you to give to parents.) For one, this kind of information prompts parents to think about how impactful they can be. We’re talking about suicide attempts, depression, substance abuse, and high-risk sexual activity as a result of parental reaction and beliefs. For parents who are supporting their LGBT youth as best they can, this information may serve as validation and a reminder that being there for LGBTQ+ youth is critical to their survival and long-term health.
PRACTICE
Parental reactions can run the gamut. There are many different kinds of reactions parents have when they learn their kids are LGBTQ+. Feelings of all sorts are okay and common, even if they are difficult, uncomfortable, and unsettling. Explore the following list, and see which feelings you’ve encountered as a parent, since learning your child is LGBTQ+.
• Surprise
• Shock
• Grief
• Loss
• Disappointment
• Fear
• Worry
• Concern
• Joy
• Celebration
• Affirmation
• Confirmation
• Neutrality
• Indifference
• Acceptance
• Love
• Affinity
• Closeness
• Intimacy
• Distance
• Anger
• Confusion
• Validation
All feelings are okay, though not all reactions are. It is important that you keep certain negative feelings to yourself, and not react with anger, aggression, rage, and threats. Clinicians and educators have the responsibility of shielding LGBTQ+ youth from these kinds of reactions, and giving you a safe space to express this—separate and apart from your kids.
REFLECT
• As parents, clinicians, and educators, exploring difficult feelings between parents and their youth can be challenging. Some people and professionals have a hard time with differences and strong negative feelings. Trust that taking the time to look within at these reactions literally strengthens all parties.
ASSESS RISKS OF COMING OUT TO FAMILY
LEARN
When LGBTQ+ youth come out to clinicians and educators, it doesn’t always mean they’ve also come out to their parents, friends, or other family members. In other cases, friends and family may learn before educators, counselors, and parents.
“Be sensitive and inquire about whom else your LGBT+ youth may have come out to.
Do not make any assumptions; unintentionally outing someone can have disastrous consequences.”
Use the following questionnaire, with youth, to assess any risks that may arise when LGBTQ+ youth come out.
REFLECT
• Discuss the answers to assessing risk.
• Create concrete plans and take action to report any threats of violence, homicide, and suicide, when and wherever necessary.
• Seek intensive treatment for any substance abuse problems and/or self-harm activities.
• Be mindful and attentive to the needs of LGBTQ+ youth, and be willing to act as an advocate on their behalf.
ASSESSING RISK QUESTIONNAIRE
What do you think will happen when you tell ________ you are ________ ?
What is your opinion of your parents’/family’s/friends’/community’s openness to the LGBTQ+ community?
What are their views and values?
What are some comments and values about your culture and family around differences, diversity, non-conforming gender expression, and sexuality?
Is there anyone you trust more when considering coming out? Is there anyone who may be most receptive and supportive?
When you share with someone other than parents, is there any risk your parents will still find out?
Is there anyone in your family you may not yet be ready to come out to? Why?
Create safety plans around potentially dangerous scenarios (i.e., collect resources and find the local LGBTQ+ youth center, friends, or extended family members who can help in an emergency).
How can you take care of yourself?
How might you offer yourself kindness, self-compassion, and the tenderness you need when coming out?
ASSESSING RELIGIOUS BELIEFS
LEARN
Religion plays a very large role in some families and cultures. While it may be waning in some parts of the country, it’s thriving in others. LGBTQ+ youth who come from religious families face an extra hurdle when embracing and affirming their authentic identity.
The following questions tease out some of the errors of logic and fact that get wrapped into religion.
PRACTICE
1. What religion/ethnicity/culture does this family affiliate with?
2. Explore the perfection of divine will, even in situations that are difficult.
3. Ask parents to explain their religion’s view of martyrs. It opens the door to touch on historical examples where something “was meant to be,” even if people didn’t like it or expect it.
4. When transpeople begin taking hormones, transition, and have surgeries, many experience relief of symptoms that previously could have led to suicide. The presence of such great relief for transpeople is miraculous, and can be viewed as divine inspiration of humankind in solving life’s challenges.
5. Sacrament is the external expression of grace. When LGBTQ+ youth authentically express themselves, it’s an example of the sacred.
6. Many religions have LGBTQ+ groups. This reflects an evolution in humanity and spirituality. Many evolutions have arisen since the Old and New Testament, as well as the Koran and other religious texts. Evolution has left some religious practices, such as keeping concubines, and sacrificing animals and people, obsolete.
7. Historically and culturally there are many examples of LGBTQ+ people succeeding and being happy. The Fa’afaine in Somalia are one example of a culture accepting third gender people. Take time to educate parents about these examples so they can see how other cultures accept it as a natural variation of humanity.
REFLECT
• Religion and culture tend to be rigid. Respect the views of others and remember the goal here is not to change any view, but rather challenge and assess thinking patterns.
• See if there is any mental flexibility that could allow parents to embrace both their LGBTQ+ youth and their religion. Wisdom is the ability to simultaneously hold contradictory ideas.
• Sometimes planting seeds of new and different ideas is the only thing to do. The rest comes later; often without your involvement or knowledge.
LGBTQ+ FAMILY FIESTA
LEARN
This activity builds on the Bias Blitz on page 104; however, it is modified for use with families. Provide each member of the family who is present for treatment a copy of the Family Fiesta worksheet on the next page. This activity is intended for youth and families who are further along in the coming out process. Do not do it with LGBTQ+ youth present, if the family is early in the coming out process.
PRACTICE
Give each member of the family present a copy of the Family Fiesta sheet on the next page. Allow 15-20 minutes for them to discuss and research the internet to find definitions of terms on the list.
Could you see yourself letting go of any of the beliefs or values listed above? If not, that’s ok; ask yourself why and write the answer here.
Have you ever noticed your views affecting your relationships? Would your LGBTQ+ child feel okay hearing some of your views? Explore beliefs that can keep people separate and negatively impact relationships.
REFLECT
Families taking the time to learn about terms and definitions related to the LGBTQ+ community creates closeness as well as informed and mindful family members. May the ensuing discussion be an enlightening fiesta for all!
Provide each member of the family who is present with their own copy of this sheet. This activity is intended for youth and families who are further along in the coming out process.
Define the following terms:
• Gay
• Lesbian
• Bisexual
• Polysexual
• Pansexual
• Omnisexual
• Skoliosexual
• Demisexual
• Grey Ace
• Asexual
• Polyamory
• Intersex
• Transfemale
• Transmale
• Cisgender
• Transgender
• Agender
• Genderfluid
• Genderqueer
• Bigender
• Trigender
• Two-spirit
• Third/Fourth/Fifth gender
• Pangender
• Demigirl
• Demiboy
• Ladyboy
• Androgyne
• Intergender
• Nonbinary
• Questioning
• Homoromantic
• Bromantic
• Panromantic
• Aromantic
*Modification:
This activity can be conducted as a family discussion. Providing each member with this page offers a visual prompt to follow along with, and take notes if desired.
FAMILIES COME OUT, TOO
LEARN
Parents, siblings, aunts, uncles, and cousins come out, too—though in very different ways and times. The following worksheet is intended for parents who are getting used to their child’s sexual orientation or gender expression, and trying to express it to others. The process of finding the words to say about what the child’s, parents’, siblings’, and the whole family’s experience is like is also part of coming out.
PRACTICE
• Apply kindness to families and their members who come out. Use the Parent Survey handout to ease parental experiences of coming out.
REFLECT
• Is there a difference between discussing coming out with family members as compared to people outside the family? There’s no right or wrong answer, though it is helpful to be mindful of the differences.
Remember nothing lasts forever, so any discomfort now will likely change somehow over time.
PARENT SURVEY
On a scale of 1-10, where 1 = not at all and 10 = completely
How comfortable are you with your child’s sexual orientation and/or gender expression?
How comfortable are you sharing your child’s sexual orientation and/or gender expression with other people in your family?
How comfortable are you sharing your child’s sexual orientation and/or gender expression with people outside your family?
What might you need to increase your comfort level, if desired? Describe your needs here:
Sometimes, it helps people to discuss coming out by first creating a sample script. Just writing out the things you might say gives you a chance to see it on paper and adjust it if necessary. Write out some preliminary thoughts, and be prepared to edit them.
COMING OUT AS THE FAMILY OF TRANSYOUTH
LEARN
For transyouth, early coming out leads to more time in life as their authentic self. From a developmental perspective, that means less trauma and dysphoria associated with feeling like they were born in the wrong body or assigned the wrong gender. Early coming out for transyouth can mean avoiding later surgeries, avoiding problematic symptoms, increased social acceptance, and also increased likelihood of a typical gender experience. In low acceptance communities and families, early coming out can be a very risky event possibly leading to homelessness, as well as physical and emotional abuse.
Consider this paradox:
Family rejection –> really bad
Family acceptance –> really good
Family reaction is an influential variable
PRACTICE
Since early coming out is associated with better outcomes, parents who are open to it can facilitate healthy development. Share the following with parents of transyouth—they need to know this:
Coming out for transyouth can occur multiple times, even with parents:
1. Telling parents: It’s challenging to tell parents, and in some cases, parents already know.
2. Accessing medical treatment (i.e., puberty blockers, hormones, surgery): In accessing medical care of any kind, but especially transition related care, transyouth need to disclose their gender.
3. Name change: When transyouth change their name, they essentially come out to everyone they know and ask them to use a different name.
4. Use of preferred pronouns: While many transyouth feel their expressed gender from a young age, it’s new for their families and they easily slip into old habits, names, and pronouns. Transyouth face having to correct their parents and family members when dead names and other gender pronouns are used, creating ‘coming out’ instances over and over again.
5. Physical effects of taking hormones: When the effects of treatment begin to show, it can lead transyouth to come out because non-binary gender expression (or gender assigned at birth) becomes too difficult to uphold any longer.
Coming out can lead to:
• Violence
• Homelessness
• Rejection
It’s a very real concern for many transyouth!
Facilitate transyouth coming out by being sensitive to these changes in their lives.
REFLECT
• Discuss these risks of coming out with parents, and assess if any exist for the transyouth you work with.
• Empower parents to support transyouth coming out when and how they are ready to.
• Offer parental support for the challenges they face with their child’s transition. All feelings are expected, and ok.