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Clinical Psychology Review, VoL 17, No. 2, pp, l9t-216, 1997
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THE cAY ADOLESCENT: STRESSORS,
ADAPTATIONS, AND PSYCHOSOCTAT
INTERVENTIONS
Michael Radkowsky and Lawrence J. Siegel
Yeshiva University
.ABSTRACT. Sociøl stigmathation hinil¿rc the abilþ of gay odolesca¿ts to achine the tashs of
adnl¿scmce. Becøuse th¿ir sexuøI id""t ty ir ilm.igrated fu ncicty, thæe yuuth hnae dificulty
fmming a þositiae inÊrúity ønd, establishing hcaltþ þcer and intimat¿ relatimships. Family
relal,inns are ofim painful and gay adnlescenß øre wsceþtíblz ø lnnelin¿ss, isolatiø¿, deþæsion,
and suicid¿. Valiilation of thcse adnlzscmts'affectionaland ercticþlings lwlps ø nomtnliz¿ tÌwir
adolnscmce, as does por.tiding thent. with a
Ltd
þm grouþ of otfur gay gouth.
@
1997 EkeuiÊr Sciø¿ce
.In order for a person to lead a productive,
psychologically healthy life, certain
developmental taslc must be mastered during adolescence. These tasks include
adjusting to the phpical and emotional changes of puberty, establishing effective
social a¡rd working relationships with peers, achieving independence from primary
caretakers, preparing for a vocation, and moving toward a sense of values and
definable identity (Davis, Anderson, Linkowski, Berger, & Feinstein, 1985; Dempse¡
1994; Sullir¡an & Schneider, 1987). McAnarney (1985) states that the ultimate goal of
adolescence is the emergence of a secure identity, a positive sense of self, and the
capability to merge with another in a truly intimate relationship.
This paper will explore the literature on gay adolescents. Although these adolescents are a heterogeneous group, "there are patterns to the social pressures they
encounter and to their psychologic coping strategies, g¡nirg some unity to their
psychosocial experiences" (Gonsiorek, 1988, p. 114). Like all youth, gay adolescents
must achieve the tasks of their age group. However, accomplishment of these tasks can
be complicated by conflicts that arise as these adolescents become aware of their
sexual orientation and the implications this orientation will have for their lives. Gay
adolescents must deal with developing an identity within the conrext of social stigmadzation, often without support of family, peers, schools, and service providen. con-
{
Correspondence should be addressed to LawrenceJ. Siegel, Ph.D., Ferkauf Gradr¡ate School of
Psychology, Yeshir¡¿ University, 1300 Morris Park Avenue, Bronx, NY, l0,t6l.
191
192
M.
Ra¿høushJ ann L.
J.
Sicgel
sequently, they are vulnerable to social isolation, family rejection, damaged selÊ
esteem, anxiety, depression, violence, school failure, running away, prostitution,
substance abuse, and suicide (Patterson, 1994; Uribe & Harbeck, 199f ).
GAY YOUTH: A DEFINITION
Malyon (1981) defines homosexuality as "an orientation in which same-sex affectional
and erotic desires predominate" (p. 322). The process by which any sexual orientation
develops is unknown, and is likely to be the product of multiple determinants
(Garnets & Kimmel, 1991). Although most gay people become aware of their sexual
orientation during early adolescence (Dempsey, 1994), many will deny homosexual
feelings for some time "because of the strong internal and external proscriptions to
the natural expression of their sexuality" (Bidwell, 1988, p. 4). The term ga! adol¿scent
will be used in this paper to describe all adolescenfs "who have a predominant erotic
preference for others of the same sex" (Isay, 1988, p. 43), whether or not they are
homosexually active, and whether or not they are able to consciously experience their
homosexual orientation.
STIGMATIZATION OF GAY PEOPTE
Gay people face fierce discrimination. Sexual relations between members of the same
sex are illegat in many places, including the District of Columbia and 23 of the United
States, with public humiliation, fines, and prison terms meted out as punishment. In
the United States, gay people are forbidden to openly serve in the military. Almost
universall¡ gay people are forbidden to marry, so that gay relationships are denied
societal recognition, legal protection, and numerous spousal benefits. Because gay
people usually lack equal protection under the law, they can be denied housing and
employment, or summarily fired. They are also the frequentvictims of harassment and
violence: In the United States in 1992, 1,898 anti-gay incidents were reported to victim
service agencies injust five major cities. These incidents included harassment, threats,
phpical assault, r¡andalism, arson, police abuse, and murder (National Gay &.Iæsbian
Task Force Policy Insdnrte, 1993). Parents who are homosexual can, and do, lose
custody of their children. Gay people are often prohibited from adopting children.
Wills have been overturned when a homosexual relationship is involved.
The fields of psycholog'' and psychiatry long contributed to the belief that home
sexuality is a pathology (American Psychiatric Association, 1968; Biebeç 1962). This
belief has not been supported by empirical research, and has also been refuted
conceptually and theoretically (see Gonsiorek, t99l). Yet despite the current official
stance of both fields that homosexuality is a normal, natural, and healthy variation of
sexual expression (Cabaj, 1988), a 1991 survey of clinical psychologists found biased,
inappropriate, or inadequate understanding, assessment, and intervention on a wide
range of topics related to the treatment of æy men and lesbians (Garnets, Hancock,
Cochran, Goodchilds, & Peplau, l99f ). In addition, a 1987 survey of clinical psychologists found that one in five practicing therapists still treats homosexuality as a mental
illness and,that4SVo of those surveyed do not considersuch behaviorunethical (Pope,
Tabachnick, & KeithSpiegel, 1987).
Homophobia has many roots. The term itself has been defined as "the irrational
fear or intoler¿nce of homosexuality or an irrational, persistent fear or dread of
homosexuals" (Morin & Garfinkle, 1978, p. 3l), but is often used more generally to
describe anti1..ay feelings and behaviors. Herek (1992) states that "antigay prejudice
,
i
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i
1
1
I
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I
1
I
I
'i'
I
I
1
I
ì
;
i
t
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The Gat Adol¿scmt
r9t
helps people to define who they are by directing hostility toward gay people as a
symbol of what they are not" (p. 156), and notes that "it is cultural heterosexism that
defines gay people as suitable targets that can be 'used' for meeting a variety of
psychological needs" (p. l6a). In some individuals, antigay bias may serve to defend
against their own homosexual feelings, or feelings of dependence and passivity (Isa¡
1988). Gender and gender-role attitudes may affect homophobic attitudes: Anti-gay
prejudice is higher among heterosexual males than among heterosexual females,
perhaps because of the strong linkage of masculinity to heterosexuality in American
culture; this creates strong pressures for males to affirm their masculinity by rejecting
male homosexuality, which is not culturally defined as masculine, and lesbianism,
which is perceived as negating the importance of males (Herek, 1991). The myth that
many gay men are child molesters, and other false stereotypes, further contribute to
anti-gay attitudes and behaviors (Dempse¡ l99a). Shilts (1992) describes how societal
constraints against gay individuals are due to factors that go beyond psychological
variables, including the desire to oppress and deny power to a minority group. The
negative stance of most major organized religions toward homosexuality has greatly
contributed to antigay bias in our society (Herek, l99l).
Adolescents who are becoming aware of homosexual feelings find little or no
support from peers, family, and society. Rathe¡; because homophobic beliefs are
codified into our socieÇ's religious beließ, Iaws, and social policies, antigay bias is an
intrinsic aspect of the socialization process for all youth (Malyon, l98l). Ar guy
adolescents become aware of their same-sex attraction, they begin to realize its
implications: They may lose some or all of their friends because of their sexual
orientation; being gay may imperil their future job security; as gay people, they are
especially vulnerable to harassment and assault; and society will regard any committed
relationship they may form as inferior to a heterosexual relationship (Borhek, 1988).
Those from a religious background may face considerable conflict berween their
sexual orientation and the religious doctrines that they have been taught (Borhek,
1988). The following section presents some of the effects of antigay attitudes and
actions on the emotional development of gay youth.
COPING STRATECIES
Anderson (1987) states that there are three choices gay adolescents can make in
dealing with their emerging sexual feelinç. They can hide these feelings, rry to
change them, or accept them. Similarl¡ Malyon (1981) cites three adaptations utilized
by guy adolescents: repression of same+ex desires, suppression of these desires in favor
of a heterosexual or asexual orientation, or disclosure.
Maþn describes repression as the least satisfactory response, stating that it is
almost always followed by eventual re-emergence of unintegrated feelings, leading to
panic andlor disruptiou of established coping strategies and life parterns. Suppression truncates the process of identity formation as the individual attempts fo assume
the heterosexual ralues and role expectations of society.
According to Troiden (1989), gay adolescents typically respond to identiry confusion with either denial, repain redefinition, avoidance, or acceptance. Through denial, as through repression, the gay adolescent denies his or her homosexual activities,
feelings, or fantasies. Repair, like suppression, involves the attempt to eradicare
homosexual feelings and behaviors. Redefining behavior means seeing one's behavior
as temporar¡ 'Just a stage," or "not really gay." This strategy is often reinforced by
,1-.'
194
M. Radhnwsþ and L. J. Siqel
I
parents and clinicians in whom gay adolescents confide, contributing to "great anxiety
to ttre teenagerwho is becoming aw:ue of a developing homosexual identity that does
not fit these expectations" (Savin-Williams, 1989a, p. 207). This interpretation also
reinforces the notion that heterosexuality is the normal outcome for all adolescents,
implicitly supporting the belief that a homosexual orientation is undesirable (Haldeman, 1994).
Aaoidnnce encompasses six strategies: inhibiting behaviors or interests the youth has
learned to associate with homosexuality, limiting exposure to the opposite sex to
prevent peers and family from learning about one's lack of heterosexual responsiveness, avoiding exposure to information about homosexuality that may confirm fears,
assuming antigay postures, establishing heterosexual involvements, and escapism, in
which the gay adolescent avoids confronting his or her homoerotic feelings through
substance abuse.
Hetrick and Martin (1987) discuss Allport's (1958) three coping strategies of
of membership, identification with the dominant
stigmatized individuals
- denial
as they relate to gay youth. These strategies are
group, and self-fulfilling negativism
(1989)
cited
by
Troiden
above. For the gay adolescent, dmia,I of
similar to those
mmbøshiþ would involve separating his or her behavior and feelings from their
meaning, for example, through viewing homosexual attraction as "just a phase."
Denial of membership postpones and complicates dealing with a stigmatized social
identity.
The belief that heterosexuality is superior to homosexuality may lead a gay adolescent to attempt to become heterosexual, that is, idÊntifi with th¿ dotninønt grouþ. Some
gay adolescents will work with a therapist who believes that such a change can be
effected. (There is extensive literahrre reviewing means by which such change is
attempted through psychotherap¡ as well as the biases and dangers inherent in these
tactics; see for example, Haldeman, 1994). More common means of attempting
change, which similarþ assault the gay adolescent's self-€steem, include use of willpower and self-recrimination to suppress homoerotic thougha and feeling;s (Anderson, 1987). Isolation may be heightened as friendships with same-sex peers axe
terminated to avoid erotic feelings. Masturbation, often associated with homosexual
fantasies, may serve to induce guilt. When attempts to change fail, the adolescent may
develop feelings of self-hatred. Aggression against one's own group, includingjoining
in anti-gay activities, can be an outcome of self-hatred, and can also be an attempt to
maintain one's "cover" (Anderson, 1987).
Allport's third coping strategy is self-fulfilling negatia'ism. In our culture, which
condemns homosexuality, a gy adolescent may pare down expectations for him- or
herself. The attitude may develop that one's own efforts mean nothing, because a gay
identity is an insurmountable barrier to achievement. Such an attitude can affect
issues ranging from education and job choices to safer sex practices.
Gay adolescents may constantly try to please others in an attempt to Prove to
themselves that they are lov¿ble "despite" their sexual orientation, a strategy that ca¡r
lead to "loss of identity, self-neglect, disregard for personal needs, and destructive
habits of caretaking others" (Gonsiorek, 1988, p. 118) . Alternativel¡ these youth may
pour their energies into academics or hobbies. "This avoidance may be destructive by
compromising inte{personal social skills development" (Gonsiorek, 1988, p. 118).
Some gay adolescents may cross-dress or exhibit other "flamboyant" behavior.
Martin and Hetrick state that this is often "a means of coping with society's attitudes
by exaggerating the behaviors expected by society" (1988, p.177), and posit that
Tht
Goy Adabscmt
195
crossdressing also may reflect an acceptance of societal misconceptions that equate
homosexuality with crossgender behavior. Such behavior may also reflect a willingness
or desire to challenge societal norms (Uribe & Harbeck, 1991)LEARNING TO HIDE
Goffman (1963) describes two types of stigmatized individuals, the discredited and t̡e
discreditable. Discrediæd gay adolescents
- those whose gay identity is either susmay be subject to ostracism and hostility byfamily and peen. They
pected or known
may face verbal harassment, name-calling, baiting, and practical jokes. Physical assault
can also occur (Uribe & Harbeck, l99l).
The discreditable individual is one who is able to hide, and does so. A discreditable
gay adolescent, who sees what happens to gay adolescents whose sexual orientation is
discovered, may spend an enormous amount of energy constantly monitoring what
should be unconscious and automatic behavior (4.D. Martin, 1982). These youth live
with an ever-present fear that dress, speech, walk, interests, friends, and expression,
could all reveal a homosexual orientation (Martin & Hetrick, 1988). Therefore, "at a
time when heterosexual adolescents are learning how to socialize, young gay people
are learning to conceal large areas of their lives from family and friends" (Hetrick &
Martin, 1984, p. 11).
According to Hetrick and Martin (1984), constant self-monitoring reinforces lowered self-esteem and a sense of worthlessness. The adolescent who must hide learns to
interact on the basis of deceit governed by fear of discovery, creating an increasing
sense of isolation. "What should be spontaneous expressions of affection or happiness
become moments of agonizing fear and uncertainty" (Anderson, 1987, p. 175).
Each act of deception, in addition to the constant self-monitoring of that which is
automatic for others, reinforces the belief in one's difference and inferiority (A'D.
Martin, 1982). "The fear that others can disrespect a person because of something he
shows means that he is always insecure in his contact with other people . . . The self
is unable to disguise or exclude a definite formulation that reads, 'I am inferior.
Therefore, people will dislike me and I cannot be secure with them"' (Perr¡ Gawell,
& Gibbon, 1956, p. 36).
PEER RETATIONS
During adolescence, the peer group becomes increasingly important as a place to
experiment wittr new roles and to be exposed to new ideas. In terms of both present
and future social dynamics, it is vital that adolescents be accepted by peers with whom
they can establish friendly as well as intimate relationships (Anderson, 1987).
For gay adolescents, peer relationships are often unfulfilling. As mentioned above,
the necessity of hiding their intimate feelings, in order to prevent discovery of their
sexual orientation, keeps most gay adolescents isolated from their peers. Gay youth
may also have affinities for cross-gender activities, and may feel the need to hide such
interests for fear of ridicule (Martin & Hetrick, 1988). In addition, development of
nonerotic friendships is often hindered because gay youth may feel the need to
distance themselves from peers of both sexes for fear that closeness will be misunderstood (Martin & Hetrick, 1988). Anderson (1987) notes that the wealth of heterosexual and heterosocial opportunities available can be frustrating and isolating to gay
adolescents who also seek involvement in an accepting peer group that offers the
possibility of establishing intimate relationships- Bidwell (1988, p. 5) states:
r96
M.
Radhnwshy and, L.
J.
Sicgel
Many of those rites of passage through which other teens pass are not open to the g'ay and
lesbian adolescent. The gliances and shysmiles exchanged across a classroom, the sending
of a valentine, the agony of the first ælephone call asking for a date, the shared bag of
popcorn in a movie theater and the walk home on a moonlit night with arms about one
another, the first kiss and touch
all of these are simply not realities for most gay and
lesbian teens or are experienced heterosexually with a sense of falseness and confusion.
-
Although there is a \ariety of gay-oriented services, resources, and activities in most
large cities, these are primarily aimed at adults. Many individuals and organizations
shy away from providing supportive services to gay youth because they legitimately fear
lawsuits, loss of licenses or funding, and unfounded accusations of sexual exploitation,
abuse, or "promoting" homosexuality (Dempse¡ 1994). Therefore, it is extremely
difficult for gay adolescents to find a positive, supportive peer environmenL
Seeking peer contacts, many young gay males may find places to make sexual
contacts, without any accompanying social interaction. This can lead to a pattern
where sexual contact is the initial stage of peer social interaction, rather than a
behavior resulting from social and emotional intimacy. "Anonymity provides a false
sense of safety but does little to promote genuine intimacy, commitment, and selÊ
€steem" (Bidwell, 1988, p. 5). In their anonymous sexual contacts these youfh nre at
increased risk for contracting Human Immunodeficiency Virus (HIV), both because
the isolation they experience limits their knowledge of sexualiry and because they may
not care enough about their own well-being to practice safer sex (4.D. Martin, 1982).
Martin and Hetrick ( 1988) state that such contacts reinforce hiding by providing these
youth with a means to compartmentalize their lives, separ¿ting sexual behavior from
all other aspects and discouragtg fusion of sexuality and emotionality. In addition,
"
the setting and the danger of such encounters "tend to reinforce the belief that a
homosexual orientation is all that society said it is
sick, deviant" despicable" (p.
-
171).
Among gay youth, females are less likely than males to engage in anonymous
same{ex encounters, perhaps because women are socialized differently from men.
Instead of acting on their same-sex attraction, they may become pregnant in an effort
to "prove" their heterosexuality (Hetrick & Martin, 1987).
FAMILY
"Family acceptance is important to both gays and nongays, yet many gays hold back
a significant part of themselves from those they care about most for fear of rejection"
(Cramer & Roach, 1988, p. 80). For gay adolescents, knowing their family's expectations of heterosexual dating, marriage, and grandchildren, the contradiction posed
for these expectations by the adolescent's homosexual orienøtion is problematic.
"This sense of contradiction and failure in turn leads to guilt, shame, mgef, and a
not-unfounded fear of rejection" (Martin & Hetrick, 1988, p. 174).
Anderson (f987) discusses several maneuvers utílized by guy adolescents to defend
against fears of familial rejection should their sexual orientation become known. On
an unconscious level, these adolescents withdraw emotional investment in the family
in order to minimize the significance of possible rejection. Consciousl¡ they withdraw
from family interactions in order to minimize the likelihood of discovery. Both of
these maneuvers distance the gay adolescent from his or her family. Emotional
isolation, feeling separated affectionally and emotionally from all social networks,
Th¿ Gay Adol¿scmt
r97
works to impair feelings of selÊworth, because th. g"y adolescent feels that he or she
is unworthy of receiving love (Hetrick & Martin, 1987).
When th. g"y adolescent's peer group does include other gay persons, he or she
may feel the need to lie about innocuous and healthy social activities, for fear of
arousing familial suspicion either that many friends are of one gender or that many
friends exhibit "suspect" mannerisms. Anderson (1987) states that the guilt and
sadness that result from such deceit and distancing may be displaced onto the
adolescent's selÊconcept: Distancing is normal and occurs during the separation
process for all adolescents. Heterosexual adolescents often label their parents as the
unreasonable agents during these conflicæ, a belief for which they find support from
their peers and that protects their ego during the emancipation process. Gay adolescents, however, may believe that they are the cause of these conflicts, making it
difficult for them to maintain a positive sense of self.
For the gay adolescent, the stress of hiding a homosexual orientation can produce
a great deal of anger. "Instinctively, the gay teenager senses that his mother and father
are not parenting him as he really is, but as a heterosexual son. Implicitl¡ they
demand that he be someone he is not. Such a relationship generates great psychic
tension and discomfort that neither parents nor child understand" (Borhek, 1988, p.
124).
Gay adolescents do sometimes disclose their homosexual orientation to their parents. Their motiv¿tions and timing are usually multidetermined. Reasons include the
desire to be honest and reduce the strain of deception; increased confidence and
self-esteem resulting from self-acceptance; and also, anger (Boxer, Cook, & Herdt,
r99l).
When parents do find out about their child's homosexual orientation, their reactions can cause the adolescent great dimculty. Parental reactions usually proceed
through a series of stages similar to those of the grieving proc€ss, because parents tend
to react as though they have suffered a loss
- the loss of the child they thought they
knew, and the loss of the future they expected for their child (Patterson, lg94). "The
challenge for sexual minority youths is to understand that parents need to grieve the
loss of their heterosexual child before they can accept their sons or daughters as they
truly are. Essentiall¡ young gays and lesbians are asked to parent their parents at a
time when they themselves most need a mother's and father's love and support"
(Borhek, 1988, p. 126).
In the first stages of shock and denial, the gay adolescent may be threatened with
physical violence or may even be expelled from the home. As anger and guilt set in,
parents may attempt to persuade the adolescent to recant his or her sexual orientation. This is a difficult experience for an adolescent insecure in his or her identity and
dependent on parentâl support. The adolescent may be overwhelmed by familial
reactions and, fearing rejection, attempt to accede to the family's wishes (Anderson,
1987).
Parents will often seek a therapist who
will "change" their child's sexual orienta-
tion. As mentioned above, this approach can be extremely damaging. Howeveç a
therapist who does not view homosexuality as a pathology and who can recognize the
complexity of family dynamics can assist the family in developing an improved
relationship in which the adolescent's psychosocial development is encouraged
(Anderson, 1987). This will be explored below in greater detail.
Given society's negative attitudes toward homosexualiry, parens are not likely to be
pleased to learn of a gay child's sexual orientation. The belief that parents are
M. Radhoushy
r98
and, L.
J.
Siegel
responsible for their child's homosexual orientation, disproven but still widely be
Iieved, may cause guilt and selßrecrimination (Gordon & Gilgun, 1987). Values,
concerns with conforrnity, and religiosity are some of the factors that will influence
parental acceptance of a gay child (Collins & Zimmerman, 1983; DeVine, lg84;
Strommen, 1989). The optimal outcome is for parents to eventually discard their
fantasized heterosexual idenúty for the gay family memben reevaluate and modif
their own y¿lues around homosexuality based on intimate acquaintance with a gay
person, and accept the gay family member (Strommen, 1989).
IDENTITY FORMATION
Identity is most fully realized "where an agreement exists between who people think
they are, who they claim they are, and how others view them" (Troiden, 1989, p. 47).
The stigma that surrounds homosexuality makes identity formation difficult because
it creates problems of guilt and secrec¡ discourages gay adolescents from discussing
their emerging sexual orientation with either peers or famil¡ and makes it difficult for
these adolescents to gain access to other gay youth who could serve as a peer group.
Gay adolescents are unique in that they are unable to develop the sense of group
identity that is important for coping with discrimination. In this regard, Dank (1971)
states that:
It is sometimes said that the homosexual minority
the case of early childhood socialization,
is
like any orher minority group; but in
it is not, for the parents of a negro can
communicate to their child that he is a negro and what it is like to be a negro, but the
parents of a person who is to become homosexual do not prepare their child to be
they are not homosexual themselves and they do not communicate to hirn
homosexual
what it is like to be homosexual. (p. 182)
-
Hammersmith (198?) notes that stereotypes are selÊr¡alidating because only those
who appear to be "gay" (as defined by stereotype) are labelled ga¡ while those who
do not fit homophobic stereotypes usually "pars." As a result, gay adolescents are
deprived of peers, positive role models, and support groups that could disconfirm
negative and frightening stereotlpes, and have only stereotypes and m¡hs from which
to learn what it means to be gay.
Unlike heterosexual adolescents who have role models and instruction for courtship procedures and responsibilities in sexual relationships, ga.y adolescents have no
opportunity to learn how to manage their sexuality in a positive manner. They usually
lack models of lifelong gay relationships, and of gay relationships that include children, so they may believe that they will forever be shut out of creating a partnership
and family life (Patterson, 1994). These adolescents will find it difñcult to positively
integrate their sexual orientation into their selfconcept and sense of identity. As a
result, "they are likely to impute a more global significance to their sexual orientation
than itwarrants" (Hammersmith, 1987, p. 176).
Lack of congruence between the social identity for which th. guy adolescent has
been prepared and actual identity leads to cognitive dissonance, preventing the
formation of ego idenúty defined by Erikson (1963) as "the accrued inner confidence
that the inner sameness and continuity prepared in the pâst are matched by the
sameness and continuity of one's meanings for others" (p. 261). Festinger (1957)
noted that accurate information can resolve cognitive dissonance; yet gay adolescents
The Gay Ad,ol¿scmt
199
t
are usually denied any positive information about homosexuality, which would enable
them to integrate being gay into their identity as a positive attribute.
The AIDS epidemic may be a factor in delaying homosexual identity formation,
in men, for several reasons (Troiden, 1989). It has amplified the stigma
surrounding homosexuality; the possibility of contracting AIDS may cause gay people
to deny their erotic feelings or delay acting on them; and the association between
especially
AIDS and homosexuality may influence gay people against identifying as gay to others.
"Identity fear may replace identity pride" (Troiden, 1989, p. 69).
Internalized homophobia, "nonconscious negative thoughts, feelings, and attjtudes" (Slateq 1988, p. 227), plays a significant role in the identity formation of gay
adolescents. Maþn (1982) states that internalized homophobia influences identity
formation, self€steem, the elaboration of defenses, cognition patterns, psychological
integrity, and relations to others. Homophobic content also contributes to the propensity for guilt and intropunitiveness in gay people and contaminates self<oncept,
inducing a powerful sense of shame about one's self (Malyon, 1982). Internalized
homophobia is particularly insidious because to a large extent it is nonconscious,
continuously reinforced by societal laws, social policies, religious beliefs, and negative
media imagery.
Malyon (1982) states that because homophobic introjection preceeds homosexual
awareness, adolescent identity formation is contaminated. "The maturation of erotic
and intimate capacities is confounded by a socialized predisposition which makes
them egealien and militates against their integration" (Maþn, 1982, p. 60). Where
sexual and affectional proclivities are viewed as repugnant, an integrated and positive
identity cannot be established. "The juxtaposition of homosexual desire and acculturated self-criticism is inimical to healthy psychological development" (Malyon, 1981,
p.324).
Malyon (1981) discusses the peer group as providing the primary context in which
primitive, undifferentiated primary ties of dependency with parents are transformed
into the capacity for erotized and empathic peer attachments, eventuating in the
capacity for mature intimacy. Because erotic and affectional desires of gay adolescenLs
are regarded as unacceptable, these adolescents are denied the opportunity to engage
in peer interactions that can validate their values, interests, and needs. Rather, they are
"encouraged to obtain peer€roup y¿lidation through the development of a false
identity; that is, by the suppression of homoerotic prompting and the elaboration of
a heterosexual persona" (Malyon, 1982, p. 6l). As a result, there is an interruption in
the process of identity formation; the ego is fragmented, with those parts that define
self-concept and furnish the basis for intimacy suppressed or denied. Defenses become highly elaborated in order to maintain a false identity and to contain rhe
accompanying chronic anxiety that this entâils, so that the individual will not be
overwhelmed (Malyon, 1982).
Because integrity and selÊrespect are difficult to establish while significant aspects
of personality are hidden and regarded with shame, gay identity formation cannot be
completed until the time when same-sex attachments can be acknowledged, explored
and accepted. During the coming out process, identity issues re-emerge, and can be
acknowledged and integrated. Malyon (1981) terms this process, in which identity
formation is interrupted and then eventually completed, biphasic adolescence.
204
M. Rdkousþ and L. J.
Sicgel
oTHER CONSEQUENCES OF STTGMATTZATTON
As noted above, gay youth often experience extreme social isolation and rejection, a
diffuse sense of identity, low selfesteem, poor family and peer relationships, and an
obsessive concern with maintaining the secret of their sexual orientation. These
factors render gay adolescents rmlnerable to depression, internalized homophobia,
violence, dropping out of school, homelessness, prostitution, substance abuse, and
suicide.
Depression, hopelessness, and despair are obvious consequences of the barrage of
negaúve attitudes and behavion with which gay youth are confronted. Internalized
homophobia, fed by the misinformation that these youth take in about themselves
from the world around them, can color their world-view so that they believe they are
unworthy of happiness and success. As a result, gay adolescents may subtly and
unconsciously sabotage themselves (Gonsiorek, 1988).
Gay people are probably the most severe targets of hate violence, and surveln of bias
afnong youth find that most adolescents react more negatively to gay people than to
any other minority group (Marsiglio, 1993; State of New York Governor's Task Force
on Bias-Related Violence, 1988). In a 1988 survey of NewYork State junior and senior
high school youth, teens often added gratuitous vicious comments about gay people,
and appeared to perceive them as legitimate targets of hatred who can be openly
attacked (State of New York Governor's Task Force on Bias-Related Violence, 1988).
It is not surprising, therefore, that gay adolescents fear violence from their heterosexual peers, and are alienated, lonel¡ and uncomfortable in "peer" settings.
Gay youth are at high risk for truancy and dropping out of school. A central factor
is the tremendous stress these youth experience in maintaining their secret. Gay
adolescents will often hear antigay statements and misinformation from principals,
teachers, coaches, counselors, and peers (Uribe & Harbeck, 1991). Sex-education
classes almost universally ignore homosexuality (Uribe & Harbeck, 1991), because of
ignorance and because of homophobia; this further increases th. B"y adolescent's
sense of isolation. Those youth who do come out are often discriminated againstwhen
they attempt to participate in the most ordinary of high school rites, such as school
dances (McManus, l99t). In addition, "ridicule from teachers, harassment from
fellow students, and other discriminatory practices interfere with their ability to learn
and frequently cause them to leave school altogether" (Uribe, 1991, p. 8).
When gay teens are rejected by their families, other housing accommodations can
be dangerous. Gay youth are often blamed by administrators when sexual and other
assaults take place, accused of "flaunting" their sexuality merely by acknowledgtg
their sexual orientation (McManus, l99l). As a result of rejection by peers, famil¡
schools, and alternative institutions, many gay adolescents find no place to survive
other than the sueet. Gay youth represent 407o to 6OTo of all street youth (Kunreuther,
l99l). The need for economic sustenance means that many of these youth will turn
to prostitution in order to survive (Coleman, 1989).
SELF.DESTRUCTIVE BEHAVIORS
(
Alcohol and drugs are used by many gay adolescents to numb anxiety and depression
that result as these youth recognize their sexual orientation and feel the need to
conceal their identity; to serve as an antidote to the pain of exclusion, ridicule, and
rejection by peers and family; to provide a feeling of power that may counteract
constant der¡aluation; and to obtain a sense of identity and wholeness, as well as a
Tlu
Gay
Adpløcat
201
(
soothing that is missing in their lives (Shifrin & Solis, 1993). Because these youth lack
structured activities and meeting places, they may often find no place other than ba¡s
in which to make peer contacts.
Alcohol and substance use have been found to disinhibit sexual restraints, increasing the risk of HfV infection (Rotheram-Borus et al., 1994), and are also thoughc to
increase the risk of suicide, for several reasons: Substance rule may compound loneliness because it often results in the deterioration of important social relationships; it
can block life-evaluating functions of the ego, allowing unconscious selfdestructive
impulses to emerge; and it can reducç the inhibitions that might keep a person from
attempting suicide (Osgood, 1989).
According to Farrow (1991), gay youth may see suicide as "a way to escape the
anguish they feel" (p. 5). Most suicide attempts by æy people occur during their
youth, at the time they are struggling with their sexual identities (Farrow, l99t). Gay
youth are much more likely to attempt suicide than are heterosexual youth: The
"Report of the Secretary's Task Force on Youth Suicide" s[ates that suicide is the
leading cause of death among gay youth, with suicides by ttrese youth comprising 30%
of all adolescent suicides (Gibson, 1989). Durkheim ( l95l ) postulated that the suicide
rate r¡aries inversely with the extent of one's involvement with society. Not only are gay
adolescents isolated from their gay peers; they are also "estranged from social norms,
disconnected from theirsocial ties, and denied full participation in society" (Saunders
& Valente, 1987, p. ll).
A variety of other theories on suicide is applicable to gay youth. Farber stated that
"suicide occurs when there appears to be no available path that will lead to a tolerable
existence" (1968, p. 17). To the isolated gay adolescent seeing a future of loneliness
and discrimination, there may seem to be no such path. According to Osgood (1985),
selFhatred and low selfesteem are the basis of suicidal behavior; these are characteristics of marry g?y youth. Miller (1978) states that each person has within himself or
herself a "level of unbearability," a personal equation determining when the quality
of life reaches a level so low that there is no longer a will to live. Given societal
proscriptions and resultant inner turmoil,
adolescent to reach this level.
it
may not be too difficult for
a
gay
COMING OUT
Strommen (1989) states that the developmental task of a gay person is to reject
negative societ¿l values in order to create a selÊidentity that includes as a component
a positive affirmation of homosexuality. Doing so requires a great deal of inner
strength and confidence, as well as the support of others. Coming out often follows
adolescence, once the gay peruon is able to find a supportive peer gïoup. Yet, some
youth do come out, and selÊacceptance is certainly a healthier response than other
coping methods discussed above.
establishing
The coming out process parallels the achievements of adolescence
an identity, developing selÊesteem and socialization skills needed to maintain friendships and intimate relationships, and accepting one's own sexuality as an essential part
of identity (Dempse¡ 1994; McManus, 1991). Howevet "there is a continuous process
of negotiating whether to disclose and risk harassment or other discrimination or
whether to remain hidden and subject to the false assumption of heterosexuality"
(McManus, 1991, p. 2). Gordon and Gilgun (1987) note thatcomingout is both joyful
and sad: "Afteryears of conflict, and often loneliness and lovelessness, coming out can
M. RadhouskJ ønn L. J. Si4el
be a tremendous relief' (p. 159). Yet "the heterosexual privilege" of marriage,
children, social acceptance, and a kindred feeling to parents, siblinç, and heterosexual friends, needs to be mourned. Because of stigmatization, "the life script [of the
gay adolescentl is either full of blanks or full of negatives" (C'ordon & Gilgun, 1987,
p. 159).
Because there is a dearth of support groups and social activities for gay adolescents,
these youth are often isolated from gay peers. Larus requiring parental consent for
psychological t¡eatrnent make it difficult for gay youth to receive supportive, selfaffirming therapy. "For those who discover the truthfulness and ineviøbility of their
homosexuality and decide to contradict their previously assumed sexual identity, there
are few sources of psychological, social, or legal assistance" (Savin-Williams, 1989a, p.
209). Youth who self-identify as gey must therefore either try to complete the developmental process in a hostile heterosexual social environment or seek peer and social
support in the gay community. The former option can result in estrangement and
confusion, and the latter requires premanrre separation from parents a¡rd assumption
of adult roles and responsibilities. Yet despite the many difficulties and drawbacks of
coming out, the gay adolescent who successfirlly negotiates this process may gain a
sense of crisis competence, as well as self-respect and ego integrity (Malyon, f981).
PEER
GROUP CREATION: A NORMAUZING STRATEGY
In recent years, gay organizations in some cities have been organizing youth groups,
in order to provide gay adolescents with a nurturing, supportive peer environmenL
Similar groups exist on many college camPus€s. Such groups give these youth the
opporhrnity to make friends without hiding their sexual orientation, thereþ developing social skills and building selfesteem; and allow them to experiment with
intimate relationships. Kunreuther (1991) staæs that suPPort grouPs for gay youth
allow them to complete the developmental tasks of adolescence.
RESEARCH FINDINCS
ON GAY ADOTESCENTS
Research on gay adolescents can be problematic for several reasons. Most imporantly,
sample populations are often nonrepresentative. "The r¡ast majority of youths who will
eventually identi$ themselves as lesbian, bisexual, or gay seldom embrace this socially
ostracized label during adolescence and thus would never participate in scientific
research" (Savin-Williams, 1994, p.262). Populations used in studies selÊidenti$ as
gay, which may indicate that ttrey are more selÊaccepting, resourceful, and resilient
than the many youths who are not studied. Conversely, they may be more troubled by
their homosexual orientation tha¡r those youth who remain invisible. In addition,
some studies are retrospective, and the memories of participants may be unreliable or
shaded by evens that have occurred since the timeperiod that the study is examining
(Boxer, Cook, & Herdt, f99f ). Finalt¡ some studies deal only *ith g"y males, though
it is likely that many of the findinç would generalize to females. Accepting these
limitations, in this section we will review reler¡ant research on gay adolescents.
Discrìmínatíon, Stígmatízatíon, and their
fiuelae
194 male and female adolescents attending programs for gay youth at
community centers in metropolitan areas across the United States (D'Augelli &
Hershberger, 1993) subjects described the following barriers as affecting greater
In a study of
Thc Gøy Adal¿scart
203
i
openness about ttreir sexual orientation: Fear of losing friends (34Vo); fear of verbal
harassment at school (31Vo); fear ofjob loss (27Vo); fear ofphysical abuse at school
(26Vol; and fear of phpical harm at home (7Vo). Nearly half the sample reported
having lost at least one friend after revealing their homosexuality. Sixt¡three percent
of subjects scored above the midpoint on an "outness" dimension; íVo of subjects
described themselves as completely hidden; and,247o stated that they were completelv
ttout.tt
study of 29 g^y male youths, 30/o of subjects reported that
they had been victims of physical assaults, half of which occurred on school property.
Fifty-five percent of subjects reported receiving regular verbal abuse from peers; 37%
reported being discriminated against in education; md287o reported dropping out of
In Remafedi's (1987)
school. Fortyone percent of the sample reported having lost at least one friend
because of sexual orientation. Telljohann and Price (1993) report that in a study of 31
female arrd 89 male adolescents,TlVo of females and,7ïVo of males reported problems
at school related to their sexual orientation, including loneliness, rude comments,
threats of violence, and physical abuse.
Uribe and Harbeck (1991) met on an ongoing basis with a grouP of male and
female gay students at a LosAngeles high school. Theyfound that many students had
been called by various derogatory terms for homosexuals, even as early as elementary
school. Those who did not adhere to traditional sex roles were especially abused. Most
subjects acknowledged having hidden or continuing to hide their sexuality, and all
reported feeling that their social development had been seriously inhibited by their
homosexuality. In addition, while most were very intelligent, few were performing in
school at a level consistent with their native capacity. Uribe and Harbeck report that
low selfesteem, feelings of isolation, alienation, and inadequacywere common among
these subjects.
\
Uribe and Harbeck (1991) also interviewed 50 gay adolescents, 37 males and 13
females. In this sample, subjects reported frequent and intense verbal and physical
harassment, with teachers also participating in verbal harassment. All subjects knew at
least one person who had dropped out of school due to such harassment.
Studying male and female gay college students, D'Augelli (1992) found thatúíTo to
72Vo of subjects reported verbal or phpical abuse, with incidens of physical threats of
violence sometimes reaching 25Vo. Seventy to 80Vo of subjects attempted to remain
hidden as a response. In Hammelman's (1993) study of gay youth and young adults
(20 females and 28 males), 44Vo of subjects stated that they had been abused
emotionall¡ physicall¡ or verbally, and,62Vo cited their sexual orientation as partial or
the main reason for the abuse.
Isolation was the most frequent presenting problem among 329 male and female
adolescents presenting at a New York social service agerrcy fo. g"y adolescents
(Hetrick & Martin, 1987). Ninety-five percent of subjects reported that theyfrequently
felt separated and emotionally isolaæd from their peers because of their feelinp of
differentness. The second most frequent presenting problem was difficulties with the
family, in that subjects reported feeling estranged from their families, or fearful of
discovery and possible violence and expulsion. The third most frequent presenting
problem was violence; Over 4OVo of subjects had been attacked because of their sexual
orientation, allld 49Vo of this group had been attacked by family members.
M.
Rû¿ùoushy ønd L.
J
Sicgel
ldentÍty Formatíon
Paroski (1987), in a study of l2l male and female adolescents presenting to a New
York City gay and lesbian community center, found that antigay attitudes are absorbed
and internalized by gayyouth. Subjects had absorbed homophobic stereotypes, in that
approximately 80Vo of both males and females believed that gay men are
"l*y*
effeminate and that lesbians are alwap masculine; 37Vo of males and 567o of females
believed that all gay men dislike women; 52Vo of males and,4lVo of females believed
ttrat all lesbians dislike men; and 58Vo of males and,41Vo of females believed that all
homosexuals are unhappy.
Paroski (1987) followed 41 adolescents over an l&month period, finding evidence
of negative feelings Írmong subjeca toward their own homosexual orientation. The
majority of respondents reported feeling guilty, shameful, abnormal, and fearful of
discovery following recognition of desire to engage in same+ex activities and relationships. Seventfeight percent of respondents reported a subsequent attemPt to
"change" to a heterosexual orientation by engaging in heterosexual activities and
relationships. Howeveç 51Vo of respondents stated that ttrey had developed a positive
gay identity.
Other studies of gay adolescents have found youth to be less influenced by societal
proscriptions against homosexuality, and it is imporønt to note that self-acceptance
levels may differ betr^reen studies because subjects were questioned at different points
in their development. All of Remafedi's (1987) subjects stated that they were selÊ
accepting, and\2Vo stated that they would not change their homosexual orientation
if given rhe possibility. Boxer (1988) found that only 30% of female subjects and,207o
of male subjects reported negative feelings surrounding first s;rme-sex attractions and
fantasies; first same+ex activity elicited negative feelingrs from lSVo of females arñ,ZíVo
of males.
Faníly RelatÍonshíps
Studying a population of 317 male and female adolescents, Savin-Williams (1989b)
found a correlation between the emotional well-being of gay youths and parental
acceptånce of their sexual orientation. Female subjects were most comfortable with
their sexual orientation if they felt that their parents accepted their homosexuality;
howeveç comfort with sexual orientation was not a predictor of self-esteem. For male
subjects, parental acceptånce was a predictor of subject's comfort with his sexual
orientation when parents were perceived as important components of self-worth. In
addition, male subjects who were most comfortable with their sexual orientation had
the highest levels of self-esteem.
D'Augelli a¡rd Hershberger (1993) found that LgVo of subjects had not disclosed
their sexual orientation to family members; and that only llVo had told all family
members and experienced positive responses. Among p¿ìrents who knew of their
children's sexual orientation, 55% of mothers and 377o of fatherswere accepung;Z\Vo
of mothers and1ïVo of fathers were tolerant; 8% of mothers and l07o of f¿then were
intolerant but not rejecting; and lZVo of mothers and 187o of fathers were rejecting.
Telljohann a¡rd Price (1993), studþg 31 female and 89 male adolescents, found
that 84Vo of females' families and 74Vo of males' families were aware of the subjects'
homosexuality. Among subjects who had disclosed, 35Vo of both males and females
reported that their families had reacted in a positive/supportive manner. Fony-nro
percent of female subjects and 30Vo of male subjects indicated that their parents had
t'
:
1
i
Tlæ Gø"t Adal¿scmt
205
responded in a negative manner when they learned of their child's homosexual
orientation.
In Remafedi's (1987) study of adolescent gay males, 21% of subjects who had come
out to their parents perceived their mothers to have been supportive when informed
of their child's sexual orientation, and lÙVo of these subjects perceived their fattrers to
have been supportive. Subjecæ in Paroski's (1987) study who disclosed their sexual
orientation to their families reported initial family response to be anger or rejection
in all ca.ses, vnth 93Vo of families making attempts to change the adolescent's homosexual orientation through rr¿rious means. In a university sample of gay males,
D'Augelli (1991) found that 26Vo of mothers and, 577o of fathers were seen as
intoler¿nt or rejecting of their children after learning of their homosexual orientation.
In Uribe and Harbeck's (1991) sample of 50 gay adolescents, only íVo of male
subjecæ reported having a positive relationship with their families over the issue of
being ga¡ although the families of all male subjects knew of their homosexual
orientation. Over 50Vo of male subjects were no longer living at home. Sixty-two
percent of female subjects reported having told their parents of their sexual orientation, and all reported being told that their homosexuality was a passing phase. A
related finding was reported by Hunter and Martin (1984), who concluded from their
study of 218 male and female gay adolescents that males who disclose their sexual
orientation to family members are at greater risk for expulsion, while females whose
homosexual orientation is discovered by family members may face more physical and
emotional abuse at home. More research needs to be done on the role of sex
differences it g"y children's relationships with their Parents.
Cramer and Roach (1988), studying gay males of r¡arious ages who had come out to
their parents, found that most relationships with both parents significantly deteriorated following disclosure. Over time, however, the relationship with both parents
tended to improve and often became better than it had been prior to disclosure.
Cramer and Roach believe this improvement occurred because disclosure serves to
"relieve the burden of distance" (1988, p. 89). Interestingl¡ this study found that
"predictors" of parental homophobia, such as traditional sex-role attitudes and
religious orthodoxy, did not accurately predict negative parental reacúon to a son's
coming out.
Suhstance Use/Abuse
I
\
Rotheram-Borus et al. (1994), studying 131 predominantly minority gay and bisexual
males presenting at a social service agency for gay adolescents in NewYork City, found
high rates of lifetime subst¿nce rrse among subjects that are well above national rates
for male adolescents: For alcohol, T6Vo versus 49Vo; for marijuana, 42% versus ZlVo;
and for cocaine,/crack,25Vo versus 2Vo.RemaÍedi (1987) found that6SVo of subjects
had high rates of weekly alcohol consumption, and 58Vo were abusing substances.
Uribe and Harbeck (1991) report that of their sample of 50 gay adolescents, 97%
of male subjects acknowledged alcohol or substance abuse problems, while 54Vo of
female subjects acknowledged alcohol problems. Thirry-five percent of subjects in
Hammelman's (1993) study reported having an alcohol or drug problem, and,\9To of
these subjects cited their sexual orientatíon as partial or the main reason for their
substance use.
M. Rûnhrudq øru|L. J.
Sicgel
Finall¡ Shifrin a¡rd Solis (1992) studied a population of 191 male and 75 female
adolescents seeking counseling at a NewYork City agenc"y that provides social services
to gay youth, as well as a population of 73 male and 2 female homeless youth served
s¿une agency. Among youth seeking counseling, lTTo of males reporæd
frequent substance use; l9% of males presented with qrmptoms of chemical dependency; l87o of females reported frequent usage; and,ITVo reported problematic usage.
The three most commonly used substances were alcohol, marijuana, and cocaine.
Among the homeless youth, 1007o were addicæd to crack'
by this
SuícÍdality
As previously noted, suicides by æy youth are thought to comprise 30Vo of all
adolescent suicides (Gibson, 1989). Suicide attempts are estimated to be 40 to 100
times more common than completed suicides (Shaffer, Garland, Gould, Fisher' &
Trautman, 1988), suggesting that gay youth are extremely rnrlnerable to suicidal
behavior. In fact, many studies reveal that gay adolescents are at increased risk for
suicide and provide strong evidence that heightened risk is relaæd to conflict over
homosexual orientation. Before reviewing these studies, it should be noted that
typically, 10.87o of adolescent females attempt suicide, and 6.27o of adolescent males
attempt suicide (Rotheram-Borus, Hunter, & Rosario, 1994)'
Schneider, Farberow, and Ikuts (1989), studying a grouP of 108 adolescent and
youngadultgaymen,found thatå}To of subjectshadattemptedsuicide and'4ôVoof
these subjece had reattempted at least once. Fifty-frve percent of subjects reported
serious suicidal ideation. Family dpfunction, especially parental alcoholism, familial
phpical abuse, and familial suicide attempts, was found to be a signifrcant contributor
io suicidality in these youths, as it is in the general youth population. Sexual identity
issues also played an important role. Although almost all atæmpters were aware of
their same+ex attraction before their first suicide attempt, only 10Vo described themselves as gay or felt good about being ga,ï at that point. Twenty-five percent had
attempted suicide at about the time when they were questioning their sexual orien'
tation and/or when they first had sex with snme{ex partners. Recently- suicidal
subjects were more dependent on social supports who were rejecting of their sexuality
rhan were nonsuicidal subjects. This study found that suicidal gay youths were SraP
plingwith their sexual orientation at an earlier age than were nonsuicidal gayyouths.
In addition, those who had attempted suicide were more likely either to have not yet
disclosed their homosexual orientation, or to have experienced rejection when coming out.
Forty-nvo percent of subjects in D'Augelli and Hershberger's (1993) study rePorted
that they had made a past suicide attempt; no sex differences were found. Forty
percent of subjects reported that they had never thought about killing themselves;
307o thought about suicide rarely; 21% thought about suicide sometimes; and, SVo
frequently thought about killing themselves. The less that subjects' Parents were aware
of their child's sexual orientation, the more likely subjects were to think of suicide.
Suicidality r¡aried negatively with degree of disclosure. Attempters described themsetves as more generally open about their sexual orientation; reported greater loss of
friends as a result of their sexual orientation; were aware of their homosexual feelingls
earlier than nonattempters; and had disclosed these feelings to a nonParent family
member earlier. D'Augelli and Hershberger note that when gay adolescents disclose
at a younger age to family members, they will confront parental attitudes and re-
fh,e GoJ Adal¿scent
sponses for longer periods of time, and will need to wait longer to be able to hold
those responses at a distance and find outside sources of support.
In a study of adolescent males who selÊidentified as gay, Remafedi, Farrow, and
Deisher (1991) found thatSDVI had attempted suicide at least once, and almost one
half of these attempten¡ reported more than one attempL Less than one third of those
who had attempted suicide reported having a supportive mother or father, The mean
age of attempt was 15.5. One third of the attempts occurred in the year that subjects
identified their sexual orientation, and most attempts occurred soon thereafter.
Similar to Schneider, Farberow, and Kruls (1989) and D'Augelli and Hershberger
(1993), this study found a søtistically significant inverse relationship between age at
first self-identification as gay and suicidal behavior.
Rotheram-Borus, Hunteç and Rosario (1994), studying a predominantly minority
group of gay and bisexual male youths, found that 39Vo of subjecæ had attempted
suicide, with more than 50Vo of these subjects having made more than one attempt.
Atæmpters were more than nrice as likely than nonattempters to have dropped out of
school, to live outside their homes, and to have friends or relatives who had attempted
suicide. While there was no significant difference between attempters and nonattempters in terms of general life stressors, gay-related stressors (e.g., sexual orientation was discovered or disclosed) were significantly more common among attempters.
Subjects who had attempted suicide were 2 l/2 times more likely than nonattempters
to have disclosed their sexual orientation to parents and siblings. In addition, the
aÍiount of general stress reported by all subjects was 3 to 5 times more than that
reported by presumably heterosexual youth, suggesting a link between gay stress and
nontay stress, Prevalence of suicide attempts among this predominantly minority
sample is simila¡ to that ¿rmong predominantly non-minority, middledass gay male
adolescents. Given ethnic differences found in rates of suicide attempts in national
samples, this finding suggests that homosexuality may ounveigh other predictors of
suicidality.
Fifty percent of male subjecæ in Uribe and Harbeck's (lggl) study of 50 gay
adolescents acknowledged having attempted suicide, while 23Vo of female subjects
acknowledged having done so. Thirty-five percent of Hammelman's (1993) female
subjects and 25To of male subjects reported having attempted suicide, ,,rt¡h TlVo of
these subjects having made their attempt before age 17. Thirty-eight percent of
subjects who reported being abused had attempted suicide and 52Vo had seriously
considered suicide; 4lVo of those reporting a substance abuse problem had attempted
suicide, while 59Vo had seriowly considered suicide; artd 36Vo of those who reported
having been rejected by family members had attempted suicide, while 55% had
seriously considered suicide.
Preventíon of HIV/AIDS
I
Epidemiologic data consistently indicate that adolescents are increasingly at risk for
HtV infection (Kipke & Hein, f992). Current estimates suggest that over 100,000
adolescents are infected with HM and by the h¡rn of the century AIDS is expected to
be among the top 10 causes of death for persons ages l5 to 24 (Hein, 1992).
Several factors contribute to adolescents being a high-risk group for HIV infection.
Research evidence indicates that adolescents tend to minimize their susceptibility to
risk and often fail to develop an objective appraisal of the potential risks that they
confront (Brown, Di Clemente, & Reynolds, l99l). In addition, tlte sexual behaviors
M. Radtuutsþ and L- J.
Sicgel
of this population ofæn include multiple sexual partners and frequentlyare associated
with the use of alcohol and/or drugs, which can impair theirjudgment and decisionmaking abilities regarding safer sex practices (Hein, f 992). Finall¡ evidence continues
to indicate that adolescents have a high rate of engaging in high-risk sexual behaviors
despite the widespread ar¡ailability of information about the AIDS epidemic (Di
Clemente, f 993). For example, while studies have reported thatapproximatelyS0Vo of.
youth are sexually active prior to the age of 19, less than one third acknowledge the
use of condoms, with an even smaller number doing so on a consistent basis (Durbin,
Di Clemente, Siegel, Krasnowsk¡ L,azarus, & Camancho, 1993; Pleck, Sonenstein, &
Ku, l99l).
White the general adolescent population remains at risk for infection with HM gay
youth in particular are at even greater risk. Because gay adolescents often do not feel
comfortable socializing in an open manner, a¡rd are therefore unable to develop
appropriate sexual relationships with their peers, they may be more likely to seek out
secretive and high-risk sexual contacts (Martin & Hetrick, 1987). Furthermore, in the
process of dealing with their sexual identity and the social stigma of being homosexual, gay adolescents may deny the risks associated with sexLr^l experimentation or
exploitative sexual relationships (Dempse¡ 1994; Remafedi, 1988; Savin'Williams,
1994). Rotheram-Borus et al, (1994) , in their study of predominantly minority Bay and
bisexual males, found a high prevalence of behaviors that placed subjects at risk for
contracting and transmitting HIV. Twenty-tvrro percent of subjects bartered sex for
money or drugs and this bartering was related to a high number of sexual partners
(44Vo reported 1l or more lifetime male and female partners), thereby increasing the
risk of HIV infection. Similarly, Remafedi (1987) found that lTVo of subjects in his
study of gay male adolescents had bartered sex for money, and subjects reported a
mean of seven male sexual partners during the past year.
Given these concerru, it is imperative that gay adolescents specifically be targeted
for HIV/AIDS prevention programs (Gonsiorek, 1988). KirÐ and Di Clemente
(1994) argue that an effective program for AIDS prevention for adolescents must
address their decision-making and risk-taking behaviors by addressing such factors as
information about HIV transmission and prevention; self+fficacy and sexual negotiation skills; beliefs about their perceived susceptibility; and the barriers and benefits
to engaging in behaviors to prevent HIV infection. These authors also have identified
a number of strategies for enhancing the effectiveness of these programs for adolescents, including the use of active learning methods, activities ttrat focus on managing
social pressures to have sex, and practicing communication and negotiation skills such
as assertiveness skills and sexual risk refixal skills.
Most importantly, HIV prevention programs need to be tailored for specific groups
of adolescents in order to be both developmentally and culturally relevant (Kirby & Di
Clemente, 1994). For gay adolescents, such prevention programs are more likely to be
effective when they are provided in the context of programs that also focus on
building social support networks, selÊesteem, and positive identity (Cranston, 1992;
Remafedi, 1988). Cranston appropriately notes in this regard that the "personal
empowerment" of gay youth is a necessary prerequisite for enabling them to engage
in health behaviors such as safer sex practices.
School-based HIV prevention programs have resulted in modest changes in the
sexual behaviors of adolescents, including increasing the use of condoms during
sexual intercourse (Walter & Vaughan, f 993). However, because marry gay adolescents
who are at greatast risk for AIDS may not attend school on a regular basis, prevention
Tlu Gat
Adnl¿scent
209
programs need to be implemented in a variety of settings where gay youth can be
found, such as teen clinics, youth groups, detention centers, and homeless shelters
(Remafedi, 1988).
Recentl¡ Remafedi (1994) examined effectiveness of a comprehensive HIVIAIDS
risk reduction program on cognitive and behavioral changes in gay and bisexual
adolescents. The intervention was provided through individualized risk education
counseling and a small group peer eduation format. Specific components of the
prevention program included information about HIV transmission and prevention;
the effecs of substance use on risky sexual behaviors and ways to avoid its use in sexual
situations; methods for clear communication with sexual partners regarding risk
reduction strategies; approaches to facilitating the consistent use of condoms and
engaging in lower-risk sexual behaviors; and the use of HIV antibody testing and
counseling. This intervention program resulted in a 60Vo reduction in high-risk
behaviors (e.g., unprotected anal intercourse, drug use) from pre- to postintervention.
Peer Support Groups
on the success of peer support groups are promising. Martin and Hetrick
(1988) sh¡died socialization groups run by NewYork's Institute for the Protection of
Lesbian and Gay Youth. They found that although most clients came to the Institute
showing signs of clinical depression related to their sense of isolation and low
self-esteem, many of these feelinp disappeared when clients were introduced to peers
and had the opportunity to interact with other gay adolescents in a nonthreatening,
nonerotic atmosphere. In addition, "the presence of otïer gay and lesbian teenagers
in a supervised setting . . . led to behaviors, especially dating behaviors, similar to those
practiced by their heterosexual counterparts" (Martin & Hetrick, 1988, p. 171).
Anderson (1987), studying members of a support group for gay adolescents, stated
that the group was "enormously important to many of these adolescents because it was
the only place where they did not have to hide. In this group they could, perhaps for
the first time, express without fear parts of their actual self and develop truly close and
honest relationships" (p. 164). According to Anderson, participating in the group had
a noticeable positive effect on adolescents:
Case reports
Over a few sessions, the adolescents' affect brightened considerably as they saw orher
normal boys and girls who were gay, shared common family and school experiences, and
received concept validation of their feelings, fantasies, and behavior . . .. As myths and
stereot)?es about homosexuality were discovered not to be true, the shame about their
homosexuality and the fear of disclosure were diminished . . .. Group members often
socialized with each other outside of the group, and many close friendships, as well as a
social network of peers, developed. Most of these adolescents had been quite socially
isolaæd, and this was the first time for many that they had participated in extensive social
activities with peers outside a classroom. (p. 17Ç177)
Anderson concludes that "having the support of a gay peer group can be an
important factor in promoting the gay adolescent to meet interpersonal challenges
that are important for his or her uninterrupted development" (p. 179).
Supporting these case shrdies, Radkowsþ (1994) found rhar among a group of 70
male and female adolescents attending peer support groups for gay youth, greater
210
M.
Radhøútsh, and L.
J.
Sicgel
amounts of time spent in such groups was significantly correlated with higher levels of
self esteem and with fewer symptoms of depression; and that the more these youth
perceived their environment to be supportive and helpful, the less likeþ they were to
report feelings of internalized homophobia.
INTERVENTIONS WITH THE ADOLESCENT AND THE FAMITY
This section provides a brief overview of a basic approach for clinicians who work with
gay adolescents and their families. It is inænded to highlight some of the mqior areas
that typically necessitate some form of intervention with adolescents and/or their
parents. Readers interested in a more comprehensive discussion of therapeutic issues
and sraægies with this client population are directed to sources listed in the reference
section of this papeç especially works by Borhek (1988), Dempsey (1994), Hammersmith (1987), Hanley-Hackenbruck (1988, 1989), Malyon (1981, 1982), McManus
(1991), Slater (1988), and Strommen (1989).
It is imperative that a therapist examine his or her own biases and prejudices toward
gay and lesbian clients. If the therapist is not comfortable in working with such
persons and/or is not familiar with the needs and issues of gay adolescents, it is
unlikely that he or she will be able to provide competent, sensitive, and gay-affirming
psychological services. In such cases, a referral should be made to an appropriat€
clinician (Garnets et al., 1991, À Martin, 1982). Moreove¡ according to the ethics
code of the American Psychological Association (1992), it is not appropriate for a
therapist to enter into a therapeutic relationship *ith æy and lesbia¡r clients when it
is recognized that conflict exists between the ttrerapist and client because of the
client's sexual orientation.
Haldeman (1994) provides a thoughffirl discussion and review of programs that
have artempted to alter an individual's sexual identity. There is no evidence to indicate
rhat sexual identity is amenable to change from any type of therapeutic intervention.
Moreover, arr¿ilable evidence suggests that such Programs can produce harmful
psychological outcomes. Finall¡ Haldeman (1994) appropriately challenges the use of
such programs on ett¡ical grounds given that homosexuality is not a psychiatric
disorder and that atæmpting to modi$ a person's sexual identity only serves to
perpetuate homophobic attitudes and values.
The initial goal of the therapist is to establish a ffusting relationship with the
adolescent. It is essential that the therapist discuss the issue of confidentiality with the
adolescenr, including the limits of the confidential relationship with the therapist
The adolescent must be assured that discussions in the therapy sessions will not be
shared with anyone, including the parents, except for issues that pertain to intent to
harm self or others. While the therapist might encourage the adolescent to share
material discussed in the sessions with significant others, it should be clear that such
sharing will be done only at the adolescent's initiation.
A second goal of the therapist is to provide a nonjudgmental environment for the
adolescent in which he or she can discuss feelings, experiences, and ideas peraining
to issues of sexual identity in a free and open m¿rnner, Th. gay adolescent often is
caught in a situation in which he or she experiences confr.rsion, ignorance, guilt, and
fear. It is likely that the adolescent who has shared his or her homosexual orientation
with family, friends, or other individuals will come to therapy having experienced
some negative reactions to this disclosure. The adolescent must feel accepted by the
therapist in order to feel comfort¿ble discussing these relevant issues and concerns. As
Tlu
Ga"t Adal¿scent
211
Sobocinski (f990) has noted, the therapistmust provide an accepting, caring, and safe
environment in which these adolescents, or those uncertain of their sexual orienta-
tion, can explore ttre often confusing and painful experiences that accompany the
emergence of a gay or lesbian identity" (p. 2a6).
Once the adolescent has shared his or her sexual identity with the therapist, it is
essential to evaluate the nature of the adolescent's experience of his or her homosexuality. Some adolescents will regard their homosexual feelings with distres, for
reasons including internalized homophobia, rejection by family and friends, and
conflics with religious beliefs. Other adolescents will accept their sexual orientation
without any difficulty while experiencing problems in areas not associated with their
homosexuality. Therefore, the therapist should not automatically assume that an
adolescent who self-identifies as gay will require therapy that primarily addresses his or
her sexual orientation. As Malyon (1988) notes, the ultimate goal in working with this
group of adolescents is to help them "develop a positive self<oncept and a genuine
capacity for intimac¡ irrespective of sexual orientation" (p. 325).
Gonsiorek (1988) notes that most gay and lesbian adolescents will need preventive
mental health approaches:
Given the opportunity to develop within a supportive and informed environment, [these
youth] present no more serious mental health problems than the general adolescent
population. Thus, the focr¡s of treatment for gay and lesbian adolescents should be upon
those individuals who have psychologic concerns superimposed on their struggles with
sexual orientation and upon those adolescents who have been particularly traumatized by
their experiences as sexual rninority members. (p. lla)
Much of the therapist's work with g¿y and lesbian adolescents should consist of
providing education. This includes information on preventing AIDS (see discussion
above). As mentioned previously, these adolescents often lack accurate information
about homosexuality. Bibliotherapy, as an adjunct to counseling sessions, can serve as
an effective method of providing the adolescent with factual information about
homosexuality and dispelling misconceptions and inappropriate beliefs. There are a
number of excellent books written specifically for gay adolescents that can be used for
this purpose. The national organization Parents and Friends of Lesbians and Gays
(P-FIr{,G), headquartered in Washington, D.C., has prepared an excellent bibliography of such books, contained in a pamphlet written especially for gay adolescents.
Therapists working with this population should contact P-FLA.G in order to obtain
copies of this pamphlet to share with their patients.
Regardless of their presenting concerns, most gay adolescents can benefit from
participating in a peer support group, and should be encouraged and guided toward
such a group.As mentioned above, such groups can help reduce the sense of isolation
that many of these youth experience. They can provide a r¿luable opportunity for
developing social skills, discussing the meaning of sexual identity, sharing information, and socializing (C'onsiorek, 1988). In addition, adolescents can find in these
groups effective role models to help them manage the challenges that they must face
in the process of coming out.
Clinicians who are likely to see gay and lesbian youth should be familiar with
appropriate community resources in order to make referrals as needed. These adolescents often can benefit from a comprehensive system of care that includes a variety
212
M. Ra¿*ø)sb øMf L.J.
Siegel
of school-based programs and multi+ervice youth agencies that provide educational,
medical, mental health, and social services (Cranston, 1992).
Parental involvement in the therapeutic process will depend on whether or not
ttreir child has informed them of his or her sexual orientation. A family crisis can be
precipitated by learning about a child's homosexual identity (Haoian, 1992). Clini
cians working with the families of gay adolescents may face several tasks. First, the
ttrerapist will often need to shepherd pÍüents through a grieving Process as they
mourn the heterosexual identity that they had presumed for their child. It is important to r¡alidate the pain that parents may be experiencing, and also to encourage
parents to accept their child's true identity. Furthermore, parents need to understand
that their child's sexual orientation is not a matter of choice and is not a result of
anything they did as parents. This will usually be a slow Process.
In addition, parents, like their gay children, will often lack correct information and
knowledge about homosexuality. Bibliotherapy can provide parents with factual informarion and help dispel misconceptions. A pamphlet for parents of gay adolescents
that contains an excellent bibliography is avail¿ble from P-FIAG.
Often, the therapist will find that parents focus on the issue of their child's
homosexuality to the exclusion of other aspects of their child's life. In this siftration,
the therapist can help the parents to recognize that their child's sexu^lig is only one
facet of his or her life, and that their child's character, activities, and relationships
extend well beyond this one area. Parents need to hear that regardless of one's sexual
orienrarion, an individual can lead a healthy and firlfilling life that need not be limited
in any way.
Finall¡ just as gay adolescents benefit tremendously from attending a Peer supPort
group, parents often benefit from attending a suPPort grouP comprised of other
parents *ith æy children. These groups help to reduce parents' isolation and provide
a safe environment where they can obtain support and discuss their feeling-s about
having a gay child.
coNctusloNs
The stigmatization of homosexuality makes it difficult for gay youth to achieve the
tasks of adolescence. Peer acceptance, exploration of intimate relationshþ, individuarion, and formation of a positive identity are all hindered because these youth are
generally taught to des¡úse a vital part of themselves. And because gay adolescents
must hide their sexuality, they are denied the pleasurable and maruring experiences
of adolescent love relationships. Research indicates that the stigmatization and unhappiness these youth experience greatly increase the risk of suicide.
That many gay adolescents do eventually emerge with a positive identity suggests
that ttrey are able to develop a strong sense of crisis competence, Nevertheless, the
extreme stressors to which gay people are subject both as adolescents and as adults
take their toll in failed relationships, substa¡rce abuse, inærnalized homophobia, and
self-fi.rlfi lling negativism.
The optimal solution to this situation would be the elimination of homophobic bias.
In a society that did not stigmatize gy people, gay adolescents would not face the
stressors described in this paper. Because this bias is deeply ingrained in most aspects
of society, including social, religious, and legal institutions, the elimination of he
mophobia is unlikely.
Th¿ C,ø Ailal¿scent
213
Therefore, "the most powerfirl treaünent for the emotional concerns of gay and
lesbian youth is to normalize their experiences as adolescents" (Gonsiorek, 1988, p.
1 2l ) . Greater visibitity of positive gay role models will help gay adolescents to positively
integrate their sexual orientation into ttreir self<oncept, and make it possible for
them to envision a successfi¡l future for themselves. Validation of these adolescents'
affectional and sexual feelings as natural and healthy by significant others in their lives
may help undo rhe strong negative feelingrs that most gay youth internalize about
themselves. Providing these youth with a true peer environment may allow them to
experience the pleasures of adolescence and successfully achieve its tasks, so that they
emerge as adults secure in their identity, capable of loving and being loved. Acknowledgnm,ß- The authors wish to thankJohn Budin, M.D., and April Martin, Ph.D., for
their helpful comments on an early draft of this manuscript.
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