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DVD Cultural Diversity: Treating the LGBTQ "Coming Out" Conflict
LGBTQ continuing education MFT CEUs

Section 29
Selected Readings Bibliography/ Authors/ Instructors

CEU Answer Booklet | Table of Contents | Homosexuality
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

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Additional Readings

Race, ethnicity, gender, and generational factors associated with the coming-out process among lesbian, and bisexual individuals. (eng; includes abstract) By Grov C, Bimbi DS, Nanin JE, Parsons JT, Journal Of Sex Research [J Sex Res], ISSN: 0022-4499, 2006 May; Vol. 43 (2), pp. 115-21; PMID: 16817058

Age at coming out among gay/lesbian/bisexual (GLB) persons and sexual debut with same-gendered partners has typically been investigated in samples that do not reflect the racial and ethnic diversity of these communities. Addressing this limitation, data were collected from a diverse sample of men and women attending large-scale GLB community events in New York and Los Angeles in 2003 (N = 2,733). Compared to older cohorts, younger cohorts ( 18-24year olds) of both men and women reported significantly earlier ages for sexual debut with same-gendered partners, and earlier ages for coming out to themselves and to others. Also, women began the process at later ages than men, as they reported coming out to themselves and sexual debut with a same-gender partner approximately two years later than men. There were no racial or ethnic differences in age out to self or others; however, people of color were less likely to be out to their parents. Service providers, sexuality educators, and researchers should attend to the diversity in experience of coming out among GLB populations as they relate to the individuals' gender, age, and racial and ethnic backgrounds.
Identification with the gay, lesbian, or bisexual (GLB) community revolves around the concept of a common marginalized sexual identity. This community identification process has often been examined in the context of coming out, when an individual begins to associate her or himself personally and publicly with other GLB persons, or discloses her or his sexual identity to non-GLB persons. Demographic factors like race, ethnicity, gender, and age play important roles in the coming-out process, but few recent studies have looked at this phenomenon.
Early studies attempted to explain connections between these life events. Dank's (1971) study of 237 gay men found the average age of first sexual desire toward the same gender occurred around age 13, while acceptance of sexual identity emerged much later, around age 19. Additionally, men over the age of 30 self-identified as gay approximately three years later than men under the age of 30, indicating some cohort effect. Other studies have reported awareness of same-gender feelings among men at an average age of 13 (Bell, Weinberg, & Hammersmith, 1981; Kooden et al., 1979; McDonald, 1982) and between 14 and 16 for women (Bell et al., 1981; Riddle & Morin, 1977).
With increased visibility of the GLB community as a result of gay liberation movements and the emergence of HIV in the early 1980s, it is possible that the ages people experience milestones such as coming out to oneself, coming out to others, and same-gender sexual debut (i.e., first sexual behavior with someone of the same gender) have changed. D'Augelli and Hershberger's (1993) study of 194 ethnically diverse GLB youth (ages 15-21 years) found reported self-awareness of GLB sexual orientation at the average age of 10, but disclosure to others did not occur until about age 16. This is younger than suggested by previous studies.
Same-gender sexual debut has been investigated by a number of researchers, but none recent. Historically, gay men have been found to report sexual debut with another man at an average age of 15 (Bell et al., 1981; Kooden et al., 1979; McDonald, 1982; Troiden, 1979). Meanwhile, lesbians report sexual debut with another woman later, at about age 20 (Bell et al.; Cook, Boxer, & Herdt, 1989; Riddle & Morin, 1977).
Various theories of sexual identity development may help explain these gender differences in coming out and same-gender sexual debut (Plummer; 1975; Ponse, 1978; Troiden, 1979). Cass (1979) was the first to develop a model that could account for gay and lesbian identity development, and Troiden (1988) later adapted his theory to include both men and women. Although common models were developed, researchers have agreed that men become aware of their same-gender feelings at earlier ages than women (Bell et al., 1981; Kooden et al., 1979; McDonald, 1982; Riddle & Morin, 1977; Troiden, 1979).
Most researchers have treated coming out as a desired end, whereas failure to come out is seen as a form of resistance, an indication of self-hatred, shame, embarrassment, or some other negative psychological phenomenon (Phellas, 1999). Understanding how this process might work for individuals of varied backgrounds is of utmost importance (Phellas). In addition, one needs to understand the positive (e.g., support from family, peers, and service providers) and negative (e.g., threats of violence, discord with cultural expectations) contexts in which individuals come out (Wallace, Carter, Nanín, Keller, & Alleyne, 2002).
Race and ethnicity has not been addressed adequately in early studies on the coming-out process for GLB persons. Most findings of these studies were observed in samples composed of predominately White GLB persons. Only recently have researchers attempted to address issues related to racial and ethnic diversity within and across GLB communities (see Battle, Cohen, Warren, Fergerson, & Audam, 2000).
Factors such as race, ethnicity, gender, and age may interact with the coming-out process (Rosario, Schrimshaw, & Hunter, 2004). Phellas (1999) reported that disclosure of GLB sexual orientation to a family member presents challenges to ethnic minority families, who tend not to discuss sexuality issues and presume a heterosexual orientation. Also, researchers do not discount the impact that racism within the predominately-White GLB community can have on GLB people of color (Icard, 1986; Loicano, 1989; Martinez & Sullivan, 1998; Savin-Williams, 1997) such that prejudice and discrimination alienates GLB people of color (Rosario et al., 2004).
Based on knowledge of the substantial changes that have occurred both within society and within GLB communities, we hypothesized that age-cohort differences would exist among GLB adults in terms of the coming-out process, with younger individuals reporting beginning this process at an earlier age. Furthermore, we hypothesized that compared to GLB people of color. White individuals would report coming out earlier. Finally, we hypothesized that women would report coming out later than men.


Participants and Procedure

A cross-sectional street-intercept survey method (Miller, Wilder, Stillman, & Becker, 1997) was used to administer the "Sex and Love Survey, Version 2.0" to 2.733 participants at a series of GLB community events in New York City and Los Angeles between the fall of 2003 and the spring of 2004. The intercept survey approach to collecting data has been used in previous studies, including those focused on GLB persons, and has been shown to provide data that is comparable to that obtained from more methodologically rigorous approaches (Halkitis & Parsons, 2002; Koken, Parsons, Bimbi, & Severino, 2005).
The response rate was high, with 82.9% of individuals consenting to complete a survey. As an incentive, those completing the 15-20 minute questionnaire were provided with a voucher for free admission to a movie. The survey instrument included items that assessed experience with a broad range of sexual behaviors, history of sexually transmitted infections, substance use, physical health, and a series of scales related to psychological well-being. This study was conducted by the Center for HIV/AIDS Educational Studies and Training (CHEST) and approved by the Institutional Review Board of the authors.
To protect their confidentiality, participants were given the survey on a clipboard so they could step away from others to complete the questionnaire. Participants were also requested not to include any identifying information on the surveys. Upon completion, participants deposited their survey into a secure box at the event. Data were entered into an SPSS database and subsequently verified by project staff for accuracy.


Demographics. Participants were asked to indicate age, sexual identity, and race/ethnicity (by checking all that apply). Response categories to race/ethnicity included African American, Asian/Pacific Islander, European/White, Hispanic/Latino, and Other (Specify).
Coming out and sexual debut. Three separate questions were included following Floyd and Stein's (2002) example of the different aspects of coming out. Participants were asked to indicate the age they admitted to themselves they were GLB, the age they told another person they were GLB, and whether or not their parent/s (or person/s who raised them) were aware of their sexual activity with same-gendered partners. Finally, participants were asked to indicate the age they first had sex with a same-gendered partner.

Analytic Plan

We performed cross-tabulations and chi-square statistical tests to compare categorical data such as race/ethnicity, gender, and age cohorts. Mean differences by gender were compared using t-tests. Finally, in cases where categorical variables containing more than two categories (such as race and ethnicity) were compared across a continuous variable (such as age of first sex with someone of the same gender), we used ANOVA multiple comparisons and Bonferroni post-hoc analyses.
Age, originally an open-ended item, was recoded into age-cohort categories: 18 to 24; 25 to 34; 35 to 44; 45 to 54; and over 55. The youngest age cohort contained individuals spanning seven years, while older cohorts span ten years. Young adults, particularly those in their late teens and early twenties, are at a unique developmental phase called emerging adulthood (Arnett, 2004). Although ages in this cohort are unevenly balanced from other cohorts in this analysis, it is developmentally more homogenous than having combined all 18 to 29 year olds together.


Approximately 15% (n = 400) of the sample were female. African Americans comprised 10% (n = 274), Asian/Pacific Islanders 6.3% (n = 172), Latino/a 14.6% (n = 398), White 62% (n = 1,695), and Other 6.8% (n = 185). The mean age was 37.4, with a range between 18 and 84 (SD = 10.96). (Refer to Table 1 for demographic characteristics by gender). Approximately 2.5% (n = 10) of women identified as Asian/Pacific Islander and were recoded into the Other group due to the small frequency. Women in the sample were, on average, younger (M = 33.9) than males (M = 38.1), t( 2,724) = 7.09, p < .001.
Among men, younger cohorts were more racially and ethnically diverse. For example, 79.3% (n = 135) of men over the age of 55 were White, compared to only 53.1% (n = 119) of men between ages 18 to 24, χ² ( 16) = 115.43, p < .001 (see Table 2). Similarly, there were more women of color among the younger female participants; however, no statistical tests could be performed due to low expected counts in some cells.

Gender Differences in Coming Out and Sexual Debut

On average, men reported coming out to themselves at a younger age (M = 17.5) than did women (M = 19.6), t( 2,519) = 5.66, p < .001. Men were also younger (M = 17.9) than women (M = 19.8) when engaging in their first same-gender sexual experiences, t( 2 ,259) = 5.58, p < .001. There were no significant gender differences between the ages that men and women reported coming out to others, nor whether they had come out to their parents.

Age Cohort Differences in Coming Out and Sexual Debut

Among women, there were significant differences between age cohorts with regard to coming out, F ( 4,377) = 14.15, p < .001 (see Table 3). Women ages 18 to 24 reported coming out to themselves at younger ages than all older cohorts (M = 15.88). Among men, similar differences were identified between age cohorts (F[ 4,2127] = 14.15, p < .001) in that those ages 18 to 24 reported coming out to themselves at a younger age than all older cohorts (M = 15.01). Although males ages 25 to 34 (M = 16.87) and those 35 to 44 (M = 17.31) did not differ statistically in the reported age of coming out to oneself, men ages 25 to 34 came out at an earlier age than those in older cohorts, 45 to 54 (M = 19.26) and 55 and above (M = 20.31).
Women ages 18 to 24 (M = 16.87) and 25 to 34 (M = 20.11) reported a significantly younger age at coming out to others compared to older cohorts, F ( 4,366) = 22.60, p < .001. Meanwhile, all remaining older cohorts of women did not significantly differ from one another. Men ages 18 to 24 (M = 16.94) reported coming out to others at a significantly younger age than all other age cohorts, F ( 4, 2,016) = 46.32, p < .001. In addition, men ages 25 to 34 (M = 19.84) reported coming out to others at younger ages than those 45 to 54 (M = 22.50) and 55 and above (M = 24.11).
Among men, younger cohorts were more likely to report being out to their parents than older cohorts (χ² [ 4] = 30.761, p < .001). Approximately 75% (n = 169) of men ages 18 to 24 reported being out to their parents, compared to 71% (n = 266) of men 45 to 54 and only 55% (n = 99) of men over 55 (see Table 4). Statistical analyses were not performed on women because of low expected counts in one cell.
Among women, significant differences in reported ages of sexual debut with a person of the same gender were identified across age cohorts, F ( 4,368) = 14.75, p < .001. Posthoc analyses revealed women ages 18 to 24 (M = 16.85) reported experiencing same-gender sex for the first time at significantly younger ages than those in all other age categories, with the exception of those ages 25 to 34 (M = 18.78). Women ages 35 to 44 (M = 21.33) and 45 to 54 (M = 23.00) did not significantly differ from one another in reported age of same-gender sexual debut; however, they did differ from those over 55 (M = 28.43) by more than seven years. Similar significant differences were found among men and their first reported same-gender sexual experience. Men ages 18 to 24 (M = 16.08) reported sexual debut at a younger age than those in all older age categories, F ( 4, 1,880) = 6.65, p < .001. Unique to this analysis was that none of the other male age cohorts significantly differed from one another in reported age of first same-gender sexual experience. See Table 3 for all age comparisons.

Race and Ethnicity Differences in Coming Out and Sexual Debut

Because there were uneven distributions of race across age cohorts, racial and ethnic differences in ages of coming out to self and others were assessed within each cohort, split by gender. ANOVAs conducted with these data revealed no significant differences between racial and ethnic groups in reported ages of coming out to self and coming out to others. Essentially, the age cohort differences by gender (see Table 3) were robust across race and ethnicity.
We found significant differences between racial and ethnic groups in being out to one's parents. Separate cross-tabulations were conducted for both men and women (see Table 5). Approximately 80% (n = 164) of White women reported being out to their parents, compared to 61% (n = 39) of African American women, 72% (n = 55) of Latinas, and 68% (n = 30) of women identifying as Other races. Similarly, 77% (n = 1.094) of White men indicated they were out to their parents, compared to 51% (n = 82) of Asian/Pacific Islander men, 62% (n = 118) of African American men, 69% (n = 197) of Latinos, and 71% (n = 89) of men identifying as other races. These relationships remained intact even when we split the analysis by age cohort.
We conducted ANOVAs to examine potential race and ethnicity differences in age of same-gender sexual debut. For the most part, there were no significant differences in reported age of sexual debut with same-gender partners across race and ethnicity; however, among 25- to 34-year-olds, there were significant findings. White women ages 25 to 34 (M = 19.66) reported experiencing same-gender sexual debut approximately three years after Latina women ages 25-34 (M = 16.64), F ( 3 ,125) = 3.16, p < .05. African American men ages 25 to 34 (M = 15.51) reported their first same-gender sexual experience at younger ages than Asian/Pacific Islanders (M = 19.51), Whites (M = 18.03), and men identifying as Other (M = 19.61), F ( 4,607) = 7.08, p < .001. There were no other significant racial or ethnic differences in reported sexual debut within any other age cohort categories among men or women.


This investigation was conducted to describe how race, ethnicity, age, and gender are related to the coming-out process. There has been little research that addresses gender, age, racial, and ethnic diversity within GLB communities. Among the few studies discussed, there is mounting evidence that GLB communities are highly diverse. Exploring these differences and how they relate to identity and everyday life is critical to both GLB communities and the public health arena. Then GLB communities can better address how to meet the varying needs of their members, while the public health community can better direct services, support, and interventions for GLB communities. Furthermore, exploring the differential experiences in coming out within the GLB community is critical to understanding the GLB community as a whole.
This analysis found that among both men and women, younger cohorts are coming out at earlier ages; this finding supports both previous research (Dank, 1971) and the hypotheses tested in this study. This could be due to current cultural factors impacting the coming-out process. A younger person admitting a GLB identity today does not carry the same stigma or taboo as one who did so two decades ago. As a result, age of both discovery and admission of GLB sexual identity may be more on par with their heterosexual youth counterparts (Graber & Archibald, 2001). This further exemplifies the need to provide GLB affirmative health education, prevention, and services to young adults as they are coming into their sexual identities.
Developing multiple identities based on sexuality, race/ethnicity, and other factors can be difficult (Wallace et al., 2002). Among GLB people of color, sexual identity often remains secondary or tertiary to other identities and roles (Phellas, 1999). A person of color may prioritize the development of a racial/ethnic identity over a sexual identity in response to many psychosocial and environmental barriers associated with race, ethnicity, and socioeconomic status (Wallace et al.).
This study indicated that people of color come out to themselves and others and experience sex with a same-gendered partner at roughly the same age as White people. In this respect, the hypothesis was not supported. The significant findings related to racial and ethnic differences in age of first sexual activity among men and women ages 25 to 34 are speculative and could be an artifact of the sample. White men and women were far more likely to be out their parents compared to all other racial and ethnic groups. Those least likely to be out were Asian/Pacific Islander men and African American men and women. These data suggest coming into a GLB identity is not hindered or delayed by being a racial or ethnic minority (see also Rosario et al., 2004); however, barriers of disclosure to parents/guardians are still evident. Nonetheless, these data do not refute that GLB persons of color manage multiple identities. Further investigation into potential barriers to being out to one's parents, and how this varies according to racial and ethnic background, is warranted.
Finally, the data indicated women experienced the coming-out process differently than men. These findings support the hypothesis and previous research (Bell et al., 1981; Kooden et al., 1979; McDonald, 1982; Riddle & Morin, 1977; Troiden, 1979). Although younger cohorts of both men and women are coming into a GLB sexual identity at earlier ages than respective older cohorts, women overall begin the process at later ages than men. Further, there is a much larger gap between older and younger cohorts in ages when the process begins among women. For example, women ages 18-24 came out when they were more than 10 years younger than women over 55, compared to a seven-year gap between men in comparable age categories. Likewise, younger participants experienced sexual debut with the same gender at earlier ages than older participants, and this age gap was more pronounced among women.


Some limitations to the data collected for this study should be considered when evaluating the generalizability of these findings. These results do not adequately represent all facets of the GLB community, but they give a comprehensive picture of the individuals that attend large-scale GLB events. The venues at which data were collected may not represent individuals who live outside of large urban cities. Since the GLB community is not restricted to metropolitan areas, further investigation into less densely-populated areas is warranted.
Lack of comparative racial and ethnic diversity among older GLB cohorts suggests a need for specific outreach in working with older GLB people of color. Since these data were collected at large-scale venues, lack of equal representation suggests older GLB people of color may not have had the desire to attend these events. As discussed in previous research, GLB people of color carry multiple identities. The salience of other identities could be stronger among older individuals (Bergung, 2004). Lack of representation among older GLB people of color could also be attributed to long-standing impacts of racism (Icard, 1986; Loicano, 1989; Martinez & Sullivan, 1998; Savin-Williams, 1997), hence reducing interest in attending the events where data were collected.
We were unsuccessful in obtaining a representative sample of Asian/Pacific Islander women. Further research is needed to understand how Asian identities might play a role in the lives of Asian/Pacific Islander lesbian and bisexual women and their involvement in the GLB community. Finally, although efforts were taken to ensure confidentiality, there was potential for biased responses due to social desirability in the reporting of sensitive information.


Few researchers have documented the diversity that exists within the GLB community in age, gender, and race/ethnicity. The findings from this analysis speak not only to other researchers who endeavor to study diversity within GLB communities, but also to service providers and health educators who continue to work with and for such communities. Treatment of psychosocial and developmental issues surrounding and within GLB communities must be culturally appropriate in order to meet the needs of the various populations represented.
It is imperative to provide support to GLB individuals during the coming-out process as it has been linked to both psychological and physical well-being (Cole. Kemeny, Taylor, & Visscher, 1996; Kennamer, Honnold. Bradford, & Hendricks, 2000; Peacock, 2000; Ryan & Futterman, 1998; Stokes & Peterson, 1998). Additionally, there is a documented relationship between lack of disclosure of sexual orientation and risk for HIV (Kennamer et al., 2000; Ryan & Futterman, 1998; Stokes & Peterson, 1998). Meanwhile, other researchers have identified a relationship between concealment of homosexual identity and diseases such as cancer (Cole et al., 1996).
Exploring issues of multiple identities among GLB people of color is central to research and program development for these populations. This study found that among both men and women, people of color were better-represented in younger age cohorts. Since these individuals are coining into both adulthood and their sexual identity, this is an important time to provide culturally-appropriate prevention and educational services for facilitating the coming-out process, as well as for fostering healthier behaviors. Researchers have found young men ages 18 to 24 are reporting more sexual risk behavior than in previous years (Bellis, Cook, Clark, Syed, & Hoskins, 2002; Catania et al., 2001). This analysis found the youngest cohort reported sex at earlier ages than all other cohorts. Thus, adolescence and early adulthood is an urgent time to provide support and educational services related to safer sex and other harm-reduction practices.
Acknowledgment and announcement of one's sexual identity to oneself and to others is a process experienced differently depending upon one's age, gender, and racial/ethnic background. The importance of addressing coming-out issues in health and social service provision, as well as in sexuality education, is apparent. These findings speak not only to health and social service providers, but also to policy makers developing sexuality education curriculum for teens and young adults. Further, they inform the arena of sexuality research and the impact historical changes of the last few decades have had on the coming-out process.





Going against the grain: supporting lesbian, gay and bisexual clients as they 'come out' By: Cowie, Helen; Rivers, Ian. British Journal of Guidance & Counselling, Nov2000, Vol. 28 Issue 4, p503-513, 11p; DOI: 10.1080/03069880020004712; (AN 3977015)


Over the last two decades, on both sides of the Atlantic, there has been an upsurge in self-help books which give opportunities for lesbians, gay men and bisexual men and women to tell their life stories (Babuscio, 1988; Jennings, 1998; Rottnek, 1999), and texts which enable therapists to understand the major issues of concern for their lesbian, gay and bisexual clients (see Alexander, 1996; Davies & Neal, 1996, 2000; Dworkin & Guttierez, 1992; Gonsiorek, 1982, 1985). Many of these publications have explored the ways in which different personal experiences and theoretical models have taken account of the personal, social and sexual development of lesbian, gay and bisexual people. They have addressed the difficulties that need to be overcome when working with clients affirmatively, and they have begun to build up a bank of case studies that provides illustrations of good practice. However, while it may be argued that there are signs that a new trend is emerging in terms of therapists' attitudes towards sexual orientation, as Widdowson (1999) has pointed out, there remain some psychotherapeutic and counselling perspectives that have yet to address the challenges faced by practitioners in supporting lesbian, gay and bisexual clients.
Hitchings (1994) has argued that not only have the last 20 years witnessed a shift in the attitudes of many psychotherapists towards a more affirmative view of homosexuality and, by implication, bisexuality (and that this shift has reflected changes in legislation and an increased awareness of lesbian, gay and bisexual issues), but it has also been necessary for those offering support, advice or counselling to lesbian, gay and bisexual clients to recognise and address the prejudices they hold:
‘When working with gay men or lesbians, irrespective of
whether or not the psychotherapist is gay or lesbian
themselves, a therapist needs to have explored their own
sexuality and at least to some degree have transcended the
sex-role stereotypes offered to us in our society’
(p. 121).

It is Hitchings' belief that practitioners should not only have resolved their own prejudices with respect to lesbian, gay and bisexual clients, but that they should also be open to the idea of adopting affirmative models of psychotherapy, and be ready to acknowledge the courage and resilience of their clients who have broken with perceived social norms and to a certain degree ‘created’ or ‘recreated’ their own lifestyles. He has argued further that, for those practitioners who are themselves lesbian, gay or bisexual, they should have reached a point in their own identity development or ‘coming out’ (i.e. disclosure of sexual orientation to others) where they will have moved from a point of identity confusion and questioning through to tolerance, acceptance and pride and ultimately to identity synthesis or resolution (see Cass, 1979, 1984, 1990; D'Augelli, 1994; Rivers, 1997).
Interestingly, it may be argued that the concept of social difference is still viewed by many practitioners as an entity external to the counselling or supportive domain — as Widdowson (1999) suggested — and where it is mentioned, it is often viewed as a potential ‘problem’. For example, in the BAC (British Association for Counselling) Counselling Reader, Palmer et al. (1996) gave considerable space to issues of social difference, but only in the context of problem areas such as those including alcohol/drug abuse, HIV, PTSD and sexual abuse. Indeed, the section referring to sexual orientation contains only two chapters: one addressing bereavement counselling and the other on the challenge of HIV/AIDS. Unfortunately, no consideration is given to the experience of being outside the mainstream in terms of sexual orientation, or on the process of ‘coming out’, and living with the potential consequences — both positive and negative. This has occurred despite the numerous texts published in the field of psychology and mental health that address issues such as coming out since the late 1970s and early 1980s (see, for example, Coleman 1981/82; McDonald, 1982; McWhirter & Mattison, 1984; Plummer, 1981; Troiden, 1979).
Although Woolfe & Dryden (1996), in their editorial commentary for their counselling psychology text, argued that the practice of counseling or offering support to an individual should be grounded in values that respect difference, feelings and subjective truths, and that emphasize choice and responsibility, they did not address sexual orientation as a counselling or support issue, and this begs the question: what provision is made within professional or everyday contexts (e.g. educational and workplace settings) to offer counseling, support or, indeed, pastoral care for lesbian, gay and bisexual clients? Furthermore, it is also worth questioning the appropriateness of the informational base upon which advice, support or counseling is offered.
As D'Augelli (1994) has pointed out, one of the difficulties in understanding lesbian, gay and bisexual client issues relates to the fact that we do not, as yet, have a model of ‘normative’ development for lesbians, gay men and bisexual men and women. Much of the information and research on lesbian, gay and bisexual issues has focused and continues to focus upon the implications of discrimination and victimization, and given that these issues may only apply to approximately 40% of lesbians, gay men and bisexual men and women at any given time (see Rivers, 1999), it would seem appropriate to consider the process of growing up within the context of being a member of a sexual minority group, but without necessarily having been exposed to overt aggression, discrimination or prejudice.
In this article, we consider the experiences of sixteen individuals whose sexual orientation is (or is perceived to be) different from the mainstream. We explore the social experience of growing up in a world that often rejects same-sex sexual attraction, and consider the role of the practitioner in facilitating the client in developing a positive view of her/his own sexuality.

The present study: what are the social and emotional needs of lesbian, gay and bisexual people as they grow up?

As noted above, our aim here is to offer an authentic description of the way in which the phenomenon of sexual orientation was experienced by a sample of 16 adults (12 gay men, 2 lesbians, 1 bisexual man and 1 bisexual woman; age range 16–36 years) who participated in a 3-year study conducted by the second author (see Rivers, 1999), and to highlight some of the issues that may be relevant to those who work with lesbian, gay and bisexual clients in various settings.
All 16 participants took part in a series of semi-structured interviews lasting approximately 1.5 hours with the second author (I.R.) which were conducted between 1995 and 1997 and were recorded on audio-tape. An ethical stance was maintained in the research process by adhering to the guidelines and codes of practice provided for counselors and researchers by the British Association for Counseling (1996).
The interviews covered a range of issues: school experiences, adolescence, work and personal relationships, and provided the authors with an opportunity to explore the self-identified needs of this particular group of lesbians and gay men without imposing a framework of directed questions or hypotheses upon the research.
In the original study, the interviews generated some 24,000 lines of text which were analyzed using Glaser & Strauss's (1967) ‘grounded theory’ technique whereby the researchers began without any predetermined hypotheses, and allowed the data to draw out common themes. In this article, we present snapshot extracts that identify some of the themes that may be relevant to those working with lesbian and gay clients in a counseling, supportive or psychotherapeutic role. Three particular aspects of lesbian and gay development are illustrated:
  • the decision to come out or disclose one's sexual orientation to others;
  • becoming aware of the implications of coming out for relationships with friends and family, and in the wider community; and
  • moving towards a more integrated sense of identity.

The decision to ‘come out'

For our 16 participants, the decision to come out was often associated with a great deal of anxiety and concern about how others around them might react. Disclosure often followed a period of great unhappiness and a sense of loneliness. The desire for acceptance and inclusion, primarily by peers, was at the forefront of participants' comments:
‘A feeling of missing out… a feeling of hearing
people in school talking about these wild parties and their
… the sexual decathalons that they were … they
were involved in. And, the … the fun playing …
playing in the park after … after school with their
friends from home. A feeling that I was being deprived of
this’ (Simon, aged 27).
‘I remember I had a girlfriend for about a year …
and it was a completely useless time for me, completely,
because I would like meet [her] at barn dances, but really I
just wanted all the others to see me with my girlfriend, so I
would look… you know… peer pressure. It was that
wonderful freedom of living in the countryside and in a good
community atmosphere, and then the private torture of knowing
that you would never be part of that community. You were alien
to it’ (Paul aged, 27).

The period immediately prior to coming out was often an experience marked by a period of increased insecurity and vulnerability:

‘I think by the time I'd got to 19, 20 or 21, I realised
that if I was going to have any future, I was going to have to
tell someone I was gay and it all hung on that…
everything hung on that. So, I told someone and then I told
another person. The whole “coming out” process took
years, but I did it bit by bit by bit, but I had to go really
low, sink to a very, very, low, low point when I was about
— a bit older than I said — 22 when I did overdose
on sleeping tablets accidentally. It wasn't an attempt to die,
but I did overdose and that would be the lowest you would
get-the absolute rock bottom — there was seriously
something wrong. I knew what was wrong, it  was just that I
wasn't being honest with myself. But once I made the leap or
whatever, that changed by telling somebody then things very,
very slowly and very, very gradually began to get better bit by
bit by bit’ (Matthew, aged 36).

However, as the following extracts indicate, a positive response from counselors, friends and, importantly, identified gay support groups did have a significant effect upon the individual's mental state:

‘I started ringing the gay switchboard, I mean they must
be credited there, they were fantastic’ (Matthew, aged
‘I first came out shortly after I came up to university.
By the time I got to Christmas of my first term I was in a
pretty rotten mental state and I knew that something had to be
done. I talked to a number of student counselors, I talked to
a couple of friends in roundabout circuitous ways, and
eventually I phoned the local gay switchboard, talked to them
and the next day [I] felt as if I was walking on air’
(Mark, aged 22).
‘I've only ever come out to good friends, or people
who've asked. There's only ever been one person I've done it to
and never heard or seen again. The response has generally been
good’ (Liam, aged 16).

Becoming aware of the implications for relationships with friends and family, and in the wider community

Coming to terms with the implications of ‘coming out’ at different stages of their lives, and in a range of social contexts, whether with friends and family, with colleagues or in public places with strangers, seemed to be a process accompanied by unpredictable and often stressful experiences for participants. Despite the existence of helpful literature and support groups, it seems likely that for many lesbian, gay and bisexual people, the process of ‘coming out’ can be followed by a period in which they have to reassess their lives in a whole host of everyday settings (as in the case of Alex below):
‘When I got back in October I thought, “Right, you
know, new people around me, still got my old friends, but I'm
going to make new friends”. My friends are really
supportive, but you can't just live with straight
friends’ (Alex, aged 19).

For others, such as Marcus and Paul, acknowledging a gay identity brought with it a number of personal and social conflicts:

‘I got involved in a social youth group and one of the
guys there asked me if I wanted to go on a pilgrimage to
Lourdes, and I said, “Yes, I quite fancy that”. At
that time I was at the stage where I thought, well yeah, it
might cure me you know … I go and it might…
because I was struggling with it [being gay] so much, I
thought, well, I might at least get some respite and come to
terms with things a bit’ (Marcus, aged 31).
‘Sometimes I worry … I know that… say if
he [boyfriend] does something in public with straight people
that's particularly camp a part of me cringes, and I hate
cringing because that's the internal homophobia. That's my
problem’ (Paul, aged 27).

It is worth noting that while being an ‘out’ gay man meant that Paul's family and friends had come to accept both his sexual orientation and his same-sex partner, he remained sensitive to the way in which society viewed homosexuality, and particularly public demonstrations of sexual orientation. His own discomfort, which he recognised as his own ‘internal homophobia’, was described in terms of a ‘problem’, and was something which he felt needed to be addressed. Yet the question arises: how can Paul address his ‘problem’ when public demonstrations of same-sex attraction are not deemed acceptable, except in certain identified gay locales?
Paul's concerns were a common feature in the majority of interviews conducted by the second author. For example, Matthew (below) pointed out that it is only in the last few years that public figures have felt able to talk openly about their homosexuality or bisexuality. In the past there were very few positive role models accessible to young lesbians, gay men and bisexual men and women as they came out. Furthermore, since little information or guidance was generally available relating to how an individual should behave in public (for example, the perceived acceptability or unacceptability of two men holding hands), the absence of positive lesbian, gay or bisexual role models meant that there were few benchmarks upon which participants were able to structure their emergent alternative identities. Yet, as Matthew attested, role models are an invaluable resource:

‘I listened to a radio programme. It was Ian McKellen
talking about how he came out to his family, and he came out to
his sort of 92 year old maiden aunt and she said sort of,
“What are you worrying about?” and that…
that sort of then really made me certain that I was doing the
right thing’ (Marcus, aged 31).

For all 16 interviewees, the support they received from their family and friends was an important aspect of their development. However, in some cases they recalled that they did not receive the unconditional support they had hoped for:

‘I went home and told my mother. She just sat there and
she nodded her head and she said, “Right, fine”,
and then started … we talked about it. Then she said,
“When you get older, if you feel that you've made a
mistake and you're not really gay then it's OK to tell
everybody that you're not gay”’ (Liam, aged 16).

While family members may not have been wholly supportive, local or university societies, or regional gay and lesbian switchboards were considered valuable resources that offered both friendship and advice for those experiencing difficulty in coming to terms with their sexual orientation.

‘Once I got to the university, I got involved in a lot of
feminism [and] tended to meet women through women's groups or
friends of friends, and I actually moved into an all-women
household at one point screaming to meet another lesbian’
(Susan, aged 30.)

It is arguable that, for the lesbian, gay and bisexual practitioners, having worked through their identity formation and having reached a point were they are comfortable with their sexual orientation, their experiences may actually provide a foundation upon which it is possible to offer guidance to clients in the absence of other positive role models (Davies, 1996). In fact, where such support was actively sought by participants, they reported that it had been beneficial. The interviews made it clear that both practitioners and volunteers are particularly effective where there is a shared understanding of the issues facing participants, although as Davies points out, it raises a number of practice issues for the individual providing support for the lesbian, gay or bisexual client.

Moving on towards a more integrated sense of identity

While being ‘out’ was perceived as a positive development in the individual, as some participants noted, it did not eradicate the residual memories of being isolated or alone as an adolescent, as Paul illustrates:
‘I don't think anyone who isn't gay can ever understand
the complete, one hundred percent humiliation you feel because
all you know is you are yourself (Paul, aged 27).

Education was also seen by participants as a way forward in supporting the individual as they came to terms with their sexual orientation, and this not only related to those responsible for pastoral care and support, but also the general community:

‘Just teach people and educate them to say that it's fine
[to be gay], it's not wrong, it's not a disease’ (Tessa,
aged 16).

Realistically, of course, legislation such as Section 28 of the 1988 Local Government Act has prevented many schools from providing effective pastoral care for young people, although the Act itself only precludes schools from ‘promoting’ homosexuality as a ‘pretended family relationship’ (see Rivers, 2000). It is notable that, for all the participants in this study, being able to talk to someone without fear of rejection or prejudice was a valuable commodity, and one which was rarely available to them as they were developing their own identities as lesbians, gay men or bisexual men and women. As Susan pointed out, when she was coming out, those around her had little idea of how to support her effectively, and as she went on to say:

‘They had no advice, no information, nowhere to offer. I
wasn't necessarily expecting them to solve my problems, but had
they — any of them — told me there was anything
like a gay switchboard or a gay support group, or anything like
that it would have been an enormous help’ (Susan, aged

Building upon the extracts quoted above, it is clear that those acting in supporting roles have a part to play in assisting lesbians, gay men and bisexual men and women address issues such as ‘coming out’ and the development of positive lesbian, gay or bisexual identities. They also have a role in maintaining those identities in a world that has yet to accept fully the lesbian, gay man or bisexual man and woman as an equal citizen. As some of the comments (above) illustrate, the residual influences of living as a lesbian, gay man or bisexual man or woman in a world of heterosexual stereotypes has a profound influence upon the individual, who without recourse to affirmative role models may have begun a process of constructing an identity which is largely founded on prevalent negative images of homosexuality.

Providing support in the real world: alternative perspectives

Our reflections on the interviews with our 16 participants suggest that there is a need for those who provide professional or voluntary support for lesbians, gay men and bisexual men and women to understand more about how social influences impact upon their personal and interpersonal lives, and to ensure a greater familiarity with existing literature on lesbian, gay and bisexual identity formation.
If a society or culture is unwilling to accept an individual because she or he is different, then the ramifications of that lack of acceptance will undoubtedly have an impact upon the efficacy of any assistance or support provided to that individual. In terms of providing support (be it counseling, psychotherapy or a befriending or mentoring process) to lesbian, gay and bisexual clients, a failure to understand the impact of social influences upon the individual may perpetuate misconceptions of illness or abnormality.
In accepting that cultural and social issues are relevant to any supportive interaction, it would seem essential that those professionals and volunteers should receive training which recommends a stance that is appreciative of diversity, and in terms of working with lesbian, gay and bisexual clients, such training should also acknowledge the resilience of those clients who have faced adversity from family, peers, work colleagues or indeed society in general and are still determined to go on. We would argue that it is only from a position of understanding the perspective of the client and by providing unconditional affirmative support that the provision of effective care can be established and maintained, and this is a view shared by Davies (1996):
‘What is important is the therapist's ability to
empathize with and accept the client. To be able to empathize
fully, the therapist needs to be able to set aside their own
fears and prejudices; to do this they need to be able to
understand the roots of them’ (p. 38).

While it is beyond the scope of this article to recommend any particular theoretical approach, texts such as the ‘Pink Therapy’ series provide a useful overview of the therapeutic perspectives currently utilized when working with lesbian, gay and bisexual clients (Davies & Neal, 1996, 2000; Neal & Davies, 2000). However, in developing the supportive role to facilitate lesbian, gay and bisexual clients, the practitioner's ability to acknowledge social difference and work with it is important. Through affirmation and support, the client's potential for personal development may be enhanced, and her or his capacity to make choices may also be enhanced. Parker (1998) proposes that through the deconstruction of the meaning of relationships practitioners can be helped to rework the supportive relationship. It may be possible for them to analyze and address issues of power objectively, and to reflect critically upon their roles of alleviating distress through providing effective and non-judgemental support. It may be argued that the lesbian, gay or bisexual practitioner's use of personal insights based upon their own experiences of growing up and identity formation may provide a way of offering guidance for clients where role models or modes of coping are not apparent. However, personal insights have limited use as they may also blur the professional nature of the practitioner-client relationship. Indeed, the fact that a number of lesbian, gay and bisexual counselors and psychotherapists specialize in lesbian, gay and bisexual issues suggests that, although not necessarily avowed, the use of shared understanding and shared insight is beneficial to the provision of support and counseling (see Davies, 1996).
Where the practitioner is not lesbian or gay, she or he should always acknowledge the client's ‘expertise’ on her or his situation, and try to obtain a sense of how the world might view the client, and how the client views the world. Ultimately, this is where Hitchings' (1994) argument is most salient: practitioners should have worked through their own feelings with respect to homosexuality and bisexuality, and through a process of self-evaluation and personal reflection new insights may develop.

The way forward

Given the limited nature of this study, and the fact that, as D'Augelli (1994) pointed out, we have yet to understand the normative process of development for lesbians, gay men and bisexual men and women, we can only suggest ways in which practitioners can assist their clients in coming out. It is clear from participants' comments that supportive networks are important in assisting individuals in coming to terms with their sexual orientation, and that those who are most likely to successfully navigate the process of coming out will be those who have access to organisations and individuals who have developed insights into growing up lesbian, gay or bisexual. We would argue that, in addition to further research focusing specifically upon the needs of lesbian, gay and bisexual clients who are coming out, there is now a sufficient body of information to warrant the inclusion of lesbian, gay and bisexual issues in those texts utilised most on counselling, counselling psychology and psychotherapy courses which no longer problematise homosexuality and bisexuality, but address personal sexual development in an affirmative manner.


The Gay Affirmative Practice Scale (GAP): A New Measure for Assessing Cultural Competence with Gay and Lesbian Clients. By: Crisp, Catherine. Social Work, Apr2006, Vol. 51 Issue 2, p115-126, 12p; (AN 21516318)

Few studies have been conducted on homophobia, a term used to refer to the broad range of negative attitudes toward gay men and lesbians (Hudson & Ricketts, 1980), in social workers. The first such study, conducted by DeCrescenzo (1984), examined homophobia in 140 mental health professionals in Los Angeles, California, and found that social workers were more homophobic than psychologists. Wisniewski and Toomey (1987) found evidence of homophobia in their study of 77 social workers in Columbus, Ohio. Using classifications developed by Hudson and Ricketts, the authors found that 4 percent were high-grade nonhomophobics; 65 percent were low-grade nonhomophobics; 25 percent were low-grade homophobics; and 6 percent were high-grade homophobics (in total, 31 percent were homophobic). Berkman and Zinberg (1997), using a mailed survey, studied 187 heterosexual social workers randomly selected from the membership rolls of the National Association of Social Workers (NASW). In contrast to Wisniewski and Toomey, Berkman and Zinberg found that only 11 percent of social workers were homophobic, based on their responses to Hudson and Ricketts' Index of Homophobia.
Although these studies yielded helpful information about social workers' attitudes toward gay and lesbian individuals, they tell us little about their social work practice with this population. Several authors have discussed the practice implications of homophobia in social workers, and many claim that homophobia may reduce the effectiveness of services offered to gay and lesbian individuals. Homophobia may thus lead practitioners to provide inferior treatment; minimize or exaggerate the importance of sexual orientation in the gay or lesbian person's life; change the topic when clients talk about gay or lesbian issues; devalue clients' feelings and experiences; deny clients access to a broad range of experiences; view clients strictly in terms of their sexual behavior; assume celibate adults and adolescents cannot identify as gay men or lesbians; inform clients that they are not gay or lesbian because they fail to meet some arbitrarily defined criterion; assume that gay or lesbian relationships are phases clients will move through; or perpetuate self-hatred experienced by some gay and lesbian clients (Brown, 1996; McHenry & Johnson, 1993; Messing, Schoenberg, & Stephens, 1984; Peterson, 1996). At its extreme, homophobia in social workers and other practitioners can lead to the use of conversion or reparative therapies, treatments aimed at changing the sexual orientation of the gay, lesbian, or bisexual person, which are explicitly condemned by NASW, the American Psychological Association (APA), the American Counseling Association, and the American Psychiatric Association (ApA) (American Academy of Pediatrics, n.d.; ApA, 1998; NASW National Committee on Lesbian, Gay, and Bisexual Issues, 2000).
Despite these assertions, few studies have assessed the relationship between social workers' attitudes and practice with gay and lesbian individuals empirically, although a relationship between the two is generally assumed (Wisniewski & Toomey, 1987). Oles and colleagues (1999) claimed that although attitudes are an important component of practice with gay men and lesbians, other factors also are required for culturally sensitive practice with these individuals. Given these limitations, additional research on social workers' behaviors in practice and beliefs about practice with gay and lesbian individuals is needed. The goal of this study was to develop a two-dimensional scale that would assess both these elements and to examine the relationship between this scale and social workers' attitudes in general toward gay and lesbian individuals.


Gay affirmative practice models provide guidelines for treating gay and lesbian individuals. Historically, this approach to practice has been the domain of psychologists with an emphasis on gay affirmative psychotherapy. More recently, social workers such as Appleby and Anastas (1998); Hunter, Shannon, Knox, and Martin (1998); and Hunter and Hickerson (2003) introduced the concept of gay affirmative practice into the social work literature and broadened the model to include the many venues in which social workers are employed.
As defined by Davies (1996), gay affirmative practice "affirms a lesbian, gay, or bisexual identity as an equally positive human experience and expression to heterosexual identity" (p. 25). Tozer and McClanahan (1999) said that affirmative? Practitioners
celebrate and advocate the validity of lesbian, gay,and bisexual
 persons and their relationships. Such a therapist goes beyond a
 neutral or null environment to counteract the life-long messages
 of homophobia and heterosexism that lesbian, gay, and bisexual
 individuals have experienced and often internalized, (p. 736)

Thus, an absence of homophobia is not sufficient to practice affirmatively. Rather, affirmative practice requires that practitioners celebrate and validate the identities of gay men and lesbians and actively work with these clients to confront their internalized homophobia to develop positive identities as gay and lesbian individuals.
Gay affirmative practice is well suited for the many settings in which social workers assist clients. According to Appleby and Anastas (1998), "There is no particular approach to psychotherapy or other forms of mental health treatment nor any particular modality of treatment — individual, couple, family, or group — that cannot be made useful for lesbian, gay, or bisexual people if approached affirmatively" (p. 286).
In addition to being applicable across a variety of social work settings, such as case management, substance abuse treatment, child welfare, and private practice, gay affirmative practice is consistent with approaches familiar to many social workers (see Figure 1):

  • Person in environment — Gay and lesbian individuals are considered in the context of the many environments in which they interact and the many roles they play. For example, when working with gay and lesbian individuals, affirmative practitioners pay attention to gay men's and lesbians' work and family settings and the degree to which they disclose their sexual orientation to others along with the roles that gay and lesbian individuals play in these environments.
  • Strengths perspective — Gay and lesbian individuals are viewed as having many strengths that can assist them in addressing their presenting issue. Where appropriate, affirmative practitioners also use other components of the strengths model, including self-determination, by supporting gay and lesbian individuals in their decisions regarding when and to whom to disclose their sexual orientation (Appleby & Anastas, 1998); a focus on health, not pathology, by viewing identities as gays or lesbians as equally healthy as heterosexual identities (Davies, 1996); and consciousness raising, by encouraging gay men and lesbians to examine the impact of homophobic forces in their lives.
  • Cultural competence models — Many of these models suggest chat culturally sensitive practice with diverse populations requires a unique knowledge base, set of attitudes and beliefs, and skill base for a given population (Sue et al., 1982). Van Den Bergh and Crisp (2004) asserted that gay affirmative practice is a form of cultural competence, similar to culturally sensitive practice with racial and ethnic minority groups.

Other aspects of gay affirmative practice should be noted. Appleby and Anastas (1998) discussed six principles of gay affirmative practice:

  1. Do not assume that a client is heterosexual.
  2. Believe that homophobia in the client and society is the problem, rather than sexual orientation.
  3. Accept an identity as a gay, lesbian, or bisexual person as a positive outcome of the helping process.
  4. Work with clients to decrease internalized homophobia that they may be experiencing so that clients can achieve a positive identity as a gay or lesbian person.
  5. Become knowledgeable about different theories of the coming out process for gay men and lesbians.
  6. Deal with one's own homophobia and heterosexual bias.

Hunter and colleagues (1998) presented guidelines for affirmative practice, including, but not limited to, the following: Understand and abide by one's professional code of ethics; value clients' sexual orientations; do not view sexual orientation as the problem; do not attempt to change clients' sexual orientation; support clients in deciding how "out" to be; and do not attempt to identify the cause of clients' sexual orientation, as doing so may be destructive to the client.
Davies (1996) claimed that holding any of the following beliefs precludes practitioners from working affirmatively with gay and lesbian individuals: Homosexuality is sinful or against God's wishes; homosexuality is sick, unnatural, or perverted; homosexuality is inferior to heterosexuality; monogamy is the only healthy way to have a relationship; gay and lesbian relationships can only be short-term, sexual, or lacking depth; gay men and lesbians are more likely to sexually abuse children; gay and lesbian parents are inferior to heterosexual parents; and bisexual individuals can decide to be gay or lesbian or heterosexual. Practitioners who hold these beliefs cannot work with gay men and lesbians in ways that convey respect for them and seek to affirm their identities as gay and lesbian individuals. Concern arises that these beliefs about gay men and lesbians lead to beliefs about practice with gay men and lesbians. For example, a belief that homosexuality is against God's wishes may lead to a belief that gay men and lesbians should be treated for their homosexuality so that they may no longer be sinners; a belief that gay men and lesbians are more likely to sexually abuse children may lead practitioners to treat gay men and lesbians for pedophilia when there is no other indication of such a disorder.


Using clinical measurement theory and the domain sampling method as a guiding framework (Crocker & Algina, 1986; Nunnally & Bernstein, 1994), I used three stages to develop and validate a self-administered scale to assess the degree to which practitioners engage in principles consistent with gay affirmative practice: ( 1) draft of an initial pool of items, ( 2) administration of the items to a pool of experts to assess the content validity of the items, and ( 3) administration of the scale to clinicians to assess the reliability and validity of the instrument and to further reduce the number of items in the scale.

Draft of Initial Pool of Items

One commonly used path to generating items for a new scale is through a review of the relevant literature (DeVellis, 1991). A review of the literature produced 23 articles and books on gay affirmative practice. From this review, it became apparent that the scale should consist of two domains: ( 1) behaviors in practice with gay and lesbian individuals and ( 2) beliefs about practice with gay and lesbian individuals (which are distinct from attitudes about gay and lesbian individuals). Across the two domains, 543 items were created from this review. After duplicate items and items that did not appear to assess the behavior or belief domains were eliminated, 372 items remained: 167 in the behavior domain and 205 in the belief domain.

Expert Review

The use of expert reviewers can be invaluable in helping a scale developer test his or her perceptions about how well items capture an intended construct (Springer, Abell, & Hudson, 2002). Accordingly, using a "snowball" sampling method, nine experts on gay affirmative practice were identified and asked to evaluate the 372 items. Consistent with methods described by Lynn (1986) and Waltz and Bausell (1981), reviewers were asked to rate each item for its relevance to the construct using a four-point Likert-type scale (1 = not relevant,2 = somewhat relevant, 3 = quite relevant, and 4 = very relevant), a method supported by Springerand colleagues (personal communication with D.Springer, PhD, University of Texas at Austin School of Social Work, September 28, 1999). Although the initial intent was to retain items with a mean score greater than or equal to 3.0, doing so would have resulted in a total of 264 items being retained for administration to the sample. Thus, the 35 items with the highest mean scores were retained, except when two items identified for retention assessed similar constructs. When this occurred, one of the two items was eliminated and the item with the next highest mean score was retained. For example, several items in the behavior domain assessed how frequently practitioners assisted clients in dealing with homophobia; the item with the highest mean score was retained. In addition, five items from each domain that were reverse scored were chosen for inclusion in the scale because including reverse-scored items in a questionnaire can reduce acquiescence response (DeVellis, 1991) and increase validity (Torabi & Ding, 1998). Following this step, 80 items were retained across the two domains.

Administration to Clinicians

Sample. Because only those who practice directly with clients were of interest in the study, NASW and APA were asked to randomly select members who met their definition of a "direct practitioner." A total of 3,000 respondents ( 1,500from each organization) were selected by these organizations for participation in the study. The decision to sample this number was based on the following:
  • Tinsley and Tinsley (1987) recommend that a minimum of five to 10 respondents per item are needed to conduct the factor analysis. Given that the factor analysis was conducted on 80 items, a minimum sample size of 400 usable surveys was needed.
  • Earlier research using mailed surveys to assess social workers' attitudes toward gay men and lesbians yielded response rates between 32 percent and 63 percent (Hardman, 1997; Harris, Nightengale, & Owen, 1995). Using this minimum response rate of 32 percent, a return of 960 usable surveys could be expected.
  • In view of the terrorist attacks on the World Trade Center and the Pentagon on September 11, 2001, and the subsequent disruption in the mail system when envelopes containing anthrax were sent to members of Congress and other individuals were infected by anthrax, concern arose that respondents might be reluctant to open mail from a source unfamiliar to them. Thus, it seemed wise to expect a much lower response rate than previous studies and to assume that the response rate might be as low as half the lowest response rate noted earlier.
  • Given that 400 responses were needed and a minimum response rate of 16 percent was assumed, a minimum sample of 2,500 was needed. To further safeguard against a low response rate, this number was rounded up to a total of 3,000 total packets mailed.

Measurement Package. Along with the 80-item Gay Affirmative Practice Scale (GAP) developed from the expert review stage, a packet consisting of the following items was mailed to each potential respondent:

  • The Attitudes Toward Lesbians and Gay Men Scale (ATLG) (short form), developed by Herek (1988), was administered to assess the convergent construct validity of the GAP's behavior domain. The ATLG has been validated with college students and members of gay and lesbian organizations and demonstrated high internal consistency (alpha of .90). Herek found that the scale correlates significantly in the expected direction with attitudes toward sex roles, with traditional family ideology, and with reports of positive contact with lesbians and gay men. Although the research correlating attitudes and behaviors provides mixed results, it was expected that people who held more positive attitudes toward gay men and lesbians would be more affirming in their practice with this population than those who held more negative attitudes toward gay men and lesbians. Thus, the behavior domain of the GAP was expected to correlate significantly with the ATLG.
  • The Heterosexual Attitudes Toward Homosexuals Scale (HATH), developed by Larsen, Reed, and Hoffman (1980), was administered to assess the convergent construct validity of the GAP's belief domain The HATH has been validated with college students, resulting in a split-half reliability of .86, and when corrected with the Spearman-Brown prophecy formula, has a split-half reliability of .92 (Larsen et al.). Larsen and colleagues found that the scale correlated significantly in the expected direction with instruments that assess religious ideology, authoritarianism, and feelings of inadequacy. As with the ATLG and the GAP's behavior domain, significant correlations between the HATH and the GAP's belief domain were expected.
  • The Marlowe-Crowne Social Desirability Scale (SDS), developed by Crowne and Marlowe (1960) and reduced to a shorter version by Strahn and Gerbasi (1972) using 10 of the original 33 items, was used to assess discriminant construct validity. The short version of the scale has high internal consistency (.876) and a correlation of .958 with the original scale (Fischer & Fick, 1993). A nonsignificant correlation with the SDS and the entire GAP was expected and would thus provide initial evidence of discriminant construct validity.
  • Twenty demographic items were chosen based on the literature review and other items of interest. These items inquired about the respondents' personal characteristics such as gender, race, and sexual orientation; religious and political affiliation; and contact with and feelings about gay men and lesbians.

Mailing Procedure. On January 25, 2002, the University of Texas at Austin University Mailing Services (UMS) distributed the instrument packets to the potential respondents using mailing labels provided by NASW and APA. A cover letter and a self-addressed business reply envelope in which to return the survey were included in the packets. According to UMS, materials should have been received by the respondents no later than February 1, 2002. Respondents were requested to return the materials to the researcher by February 15, 2002.
Assessing Reliability, Internal consistency reliability was established through an analysis of responses obtained in the administration to clinicians. Internal consistency reliability is considered a more effective method for computing reliability (Nunnally & Bernstein, 1994) and was thus the most logical method for establishing reliability in this study.
The standard error of measurement (SEM) was also computed for each domain. The SEM is an estimate of the standard deviations of error of measurement and is less influenced by differences in variance and standard deviation in different samples or populations than coefficient alpha (Springer, Abell, & Nugent, 2002). The SEM should be computed to compensate for differences in sample standard deviations. A small SEM provides evidence that the scale is reliable.
Assessing Validity. Content validity was examined and can be thought of as the degree to which items in an instrument represent the construct of interest. It is often established by having independent experts assess whether the items adequately assess the construct (Springer, 1997). Convergent construct and discriminant construct validity were assessed to examine the degree to which the GAP correlated with measures that were theoretically related to it. Construct validity is closely tied to theory and is concerned with theoretical relationships between variables (DeVellis, 1991; Springer). As multidimensional scales are collections of unidimensional scales (Hudson, 1985), convergent construct validity was established for each domain rather than for the scale as a whole, and discriminant construct validity was examined for the entire scale. Confirmatory factor analysis (CFA) using the multiple groups method (Nunnally & Bernstein, 1994) was used to establish factorial validity. This method allows the researcher to examine the correlation between each individual item and each domain in the scale. This in turn allows the researcher to confirm or disconfirm a priori hypotheses about factor loadings. The number of domains was fixed at two and were titled "belief" and "behavior." As a general rule, item correlations are considered moderately high when they load on their intended domain at or about .60 (Nunnally & Bernstein). As discussed by several authors, validating a scale is an ongoing process and does not end on completion of the aforementioned types of analyses.


Of the 3,000 surveys sent to members of NASW and APA, 488 were returned completed, for a response rate of 16.3 percent. Despite the low response rate, this study is one of the largest conducted to examine homophobia in social workers and psychologists. The majority of respondents were women (74 percent), married (69 percent), heterosexual (86 percent), Democrats (69 percent), and white (92 percent). NASW members responded at a slightly higher rate than APA members, with 53 percent of the sample indicating NASW membership. Respondents were almost evenly split between those whose highest degree was a master's (49 percent) or a doctorate (48 percent). Most respondents (59 percent) reported mental health as their primary area of practice. (Additional information about the sample can be found in Table 1).
The majority of respondents reported having at least one gay or lesbian friend (87 percent) and at least one gay or lesbian client (65 percent); only 38 percent reported having a gay or lesbian family member (Table 2). Although most (73 percent) of the respondents reported attending a workshop that included content on gay and lesbian issues, fewer than half (47 percent) reported attending a workshop with a focus on gay and lesbian issues. Respondents' feelings about gay men and lesbians were very positive and appeared to be similar, as indicated by a mean score of 82.19 (SD = 17.85) on the lesbian feeling thermometer and a mean score of 81.27 (SD = 17.52) on the gay male feeling thermometer. Additional information about characteristics of the sample can be found in Crisp (2002).

Reliability and Validity

The two domains of the initial 80-item GAP were examined for internal consistency reliability. Cronbach's alpha was .93 for the belief domain and .95 for the behavior domain. Analysis of the factor loading for each item identified 17 belief items and 29 behavior items that loaded on their respective domain at or above this level. On the basis of the factor analysis, 15 items in each domain were retained for the final version of the scale. (Additional information about the rationale for retaining or deleting specific items can be found in Crisp [2002]).

Final Version of the Gay Affirmative Practice Scale (GAP)

Reliability. The final version of the GAP consists of two 15-item domains (see the Appendix) with an overall Cronbach's alpha of .95. Cronbach's alpha is .93 for the belief domain and .94 for the behavior domain. Both domains well exceed Nunnally's (1978) minimum criteria of at least .70 to demonstrate internal consistency. Based on reliability standards set by Springer, Abell, and Nugent (2002), the reliability for both domains is "very good."
The SEM of 1.91 for the belief domain and 2.71 for the behavior domain provide evidence of the scale's reliability. Both SEM scores meet Hudson's (1999) recommendation that the SEM should be less than 5 percent (6.0 for each of these two domains) of the possible range of scores.
Validity. Evidence of validity was demonstrated using several methods. CFA revealed that each item loads on its intended domain at .60 or greater, providing support for factorial validity. Evidence of convergent construct validity was obtained by examining Pearson's r correlations between scores on the belief domain and scores on the HATH and between the behavior domain and the ATLG. The correlation between the belief domain of the GAP and the HATH was .624 (p = .000); the correlation between the behavior domain and the ATLG was .466 (p = .000). The scale is thus a strong first attempt at assessing gay affirmative practice. Both correlations were significant at the .001 level, are in the expected direction, and fall within the acceptable range of greater than or equal to .40 (Downie & Heath, 1967). Overall, there is evidence that the two domains of the GAP correlate at least adequately with the instruments with which they are expected to correlate, thus providing evidence of convergent construct validity. Evidence of discriminant construct validity was obtained by examining the correlation between the SDS and the entire 30-item GAP scale. The correlation between these two instruments was .021 and was nonsignificant (p = .691). This finding provides strong evidence that the GAP does not measure socially desirable responses and is evidence of its discriminant construct validity. The aforementioned reliability and validity analyses collectively suggest that the GAP measures gay affirmative practice.


A chief limitation of this study is the low response rate. The poor response rate may be partially attributable to a delay in the mail that caused many questionnaires to be received by respondents after the requested return date of February 15, 2002. On their completed questionnaires, 92 of the 488 respondents indicated that they received the packet after the response date. Several other factors such as a lack of time to complete the survey, lack of interest in the topic, or the length of the survey may have contributed to the low response rate. Whatever the cause of the response rate, concern arises that the nonresponders may hold different views from the responders. This concern limits the generalizability of the current study because it is not known to what degree the pool of respondents is representative of social workers and psychologists as a group.
The use of memberships lists from NASW and APA to obtain the sample also limits the study's generalizability because members of these organizations may hold different views than those who are not members of NASW and APA. In addition, social workers' and psychologists' views may not represent the views of many other helping professionals such as nurses and counselors. Generalizability is also limited by the high percent of respondents who identified as Democrat, Caucasian/white, female, married, and heterosexual.
Another limitation is that the study did not examine known-groups criterion validity to determine whether the GAP can distinguish between those who would reasonably be expected to have higher scores on the scale and those who would be reasonably expected to have lower scores on the scale. Conducting such a validity study would further reinforce claims that the scale is a valid measure of gay affirmative practice. Nevertheless, this validation study of the GAP was based on a large number of respondents, and the GAP appears to have sufficient reliability and validity.


The key issue with any measurement instrument is its utility (Springer, 1997). The GAP has many uses for social workers and other helping professionals. First, as a rapid assessment instrument, the GAP can be quickly and easily administered and scored by a variety of helping professionals in a brief amount of time. Second, practitioners can use the GAP as a self-assessment instrument to evaluate the degree to which they practice affirmatively with gay and lesbian individuals. Third, the scale can be used to assess the effectiveness of different types of educational interventions on practitioners' work with gay and lesbian individuals. Such studies might consist of training on gay and lesbian issues or treatment approaches given to one group of practitioners and withheld from another group and using the GAP to assess the impact of the training. In addition, following test — retest reliability studies, the GAP may be administered to individuals before and after different training methods and content on gay and lesbian issues to evaluate the magnitude of change in each group. Fourth, the GAP can be used to evaluate claims by students and other helping professionals that despite holding antigay attitudes, they can practice affirmatively with gay and lesbian individuals. Although many remain skeptical about these claims, this scale may be used to evaluate such claims and to further identify factors that affect clinicians' practice and beliefs about practice with gay and lesbian individuals.


Clinicians who want to improve their practice with gay and lesbian individuals have had few tools with which to evaluate their beliefs and practice with this population. This self-evaluation process is consistent with the ethics of social work as a profession, which encourage competence and respect for diversity. In addition, by evaluating their practice with gay and lesbian individuals, social workers demonstrate a commitment to culturally competent practice with members of this population, consistent with the increasing emphasis in the profession on cultural competence with diverse groups.


The moderate relationship between the domains of this scale and measures of homophobia may suggest that educational efforts targeting attitudes toward gay and lesbian individuals are insufficient to ensure gay affirmative practice. Although attitudes may be an important component of affirmative practice with gay and lesbian individuals, they may not be sufficient to ensure affirmative practice with such clients (Oles et al., 1999). It may be equally, if not more, important to educate students and practitioners about components of gay affirmative practice and ways in which they can apply this model to the many settings in which they practice. As suggested by Van Den Bergh and Crisp (2004), social work education about gay and lesbian individuals might thus address knowledge, attitudes, and skills in practice with gay men and lesbians rather than focusing almost exclusively on the relationship between attitudes and behavior.


For the past 30 years, research has focused largely on social workers' attitudes toward gay and lesbian individuals. Although this research has contributed to the knowledge base, it is time to move the focus from attitudes to an examination of beliefs and behaviors in practice with gay and lesbian individuals. In doing so, the research can move from an assumed relationship between homophobia and practice to one that is empirically tested. The development and validation of the GAP is one step in that direction.
The development and validation of this scale may also encourage others to embark on similar studies. This scale can be used in validation studies for related measures of affirmative practice and culturally competent practice with gay and lesbian individuals. The development of additional measures may facilitate research in this area and increase knowledge about practice with gay and lesbian individuals.


The GAP was developed in an attempt to bridge the gap between attitudes and behaviors in practice with gay and lesbian individuals, and by doing so gain insight into the relationship between the two. Although this study provides initial evidence of the reliability and validity of the GAP, the findings are of little practical significance unless they benefit gay and lesbian individuals who use social work and other clinical services. Gay affirmative practice is increasingly accepted as the model from which to approach practice with gay and lesbian individuals and is consistent with many social work values. Clinicians whose practice is based on this model convey support and affirmation for gay and lesbian individuals' identities, support their right to self-identify, assist them with the challenges of living in an oppressive and homophobic world, help them express positive feelings about gay and lesbian identities, and explicitly reject the use of reparative therapies. Given research that shows gay men and lesbians are more likely than heterosexual individuals to use therapeutic services (Rudolph, 1988), it is important that clinicians have measures by which to evaluate their competence with gay and lesbian individuals and be trained to treat gay men and lesbians affirmatively. The GAP provides an initial means by which to assess practice and, along with other resources on gay affirmative practice, can be used to improve practice with gay and lesbian individuals.


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Coordinating Author/Instructor: Tracy Appleton, LCSW, MEd

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The article above contains foundational information. Articles below contain optional updates.
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