Couples Therapy for Lesbians and Gay Men: The Basics

November 14, 2006 at 4:12 pm  •  Posted in Relationships by  •  0 Comments

By Patti Geier, MSW, CSW

When to Seek Treatment
What to Look for in a Therapist
Effects of Internal and External Homophobia
Adoption, Insemination, and Raising Children
Coming Out
Family Issues
Sex Roles
How Couples Therapy Can Help


When to Seek Treatment

I recently received a call from a woman who was interested in couples therapy. She and her partner were planning a wedding and thought it would be a good idea to have pre-marital counseling “to iron out a few problems.” After a few months in treatment, they agreed that the work they accomplished benefited them as a couple and as individuals. They felt ready to begin the next chapter in their lives.

I offer this example because it is so different from what I usually see. In my work with couples I have found whatever their sexual orientation  that by the time the couple comes to treatment, they are unable to talk to each other without fighting. Communication has broken down and their relationship is tense, volatile, and destructive. It is rare for couples to reach out for treatment unless they are desperate, and therapy becomes a last ditch effort before breaking up.

It’s difficult to move forward in a relationship when anger and resentment have built up to such a degree that there are few conflict-free areas of discussion. Of course, it would be much more effective to seek counseling before reaching this point.

When you and/or your partner notice that you’re fighting about the same thing over and over again without reaching a resolution, you may want to seriously consider couples therapy. If you disagree on even the most banal topics and tension underlies every interaction, seeing a professional to help you talk to each other can be a very good idea.

What to Look for in a Therapist

The most important qualities in a couple therapist are the ability to listen, empathize with, and help the members of the couple communicate their feelings and needs to each other. Unlike in individual therapy, a couples therapist needs to set ground rules so that each person has time to speak without interruption. The therapist needs to be active and skilled to keep the treatment from dissolving into the same kind of communication the couple has at home. This can be enormously helpful for people who don’t feel heard or tend to suppress their own feelings to avoid conflict.

The issue of whether to see a lesbian/gay therapist is something for each couple to decide. There are many gay-affirmative therapists to choose from, but if it is important for you and your partner to work with a lesbian or gay male therapist, you can ask a potential therapist if he or she is gay. Gay therapists tend to advertise in the local gay newspaper, if there is one in your area.

While many of the problematic dynamics that exist between lesbian and gay male couples are not significantly different from their heterosexual counterparts, the issues can be quite unique. Several instances are described below.

Effects of Internal and External Homophobia

It is difficult to describe how damaging homophobia can be for lesbians and gay men. There are the obvious forms, such as: the ban against gay marriage, gay bashing, and discrimination. Yet, other more insidious forms, like internalized homophobia, can create stress in even the best relationships.

For example, Carol and Beth came to see me because they were interested in starting a family. They were arguing about whether they were really ready to take this step. Carol was particularly upset because she felt they had agreed to begin adoption proceedings. She could not understand why Beth was back-pedaling. They had difficulty discussing this issue on their own because each time Carol brought it up, Beth would say she didn’t know why she was having second thoughts. She would shut down and withdraw. They were at a standstill and it was affecting other areas of their relationship.

After a few sessions, Beth began to cry. She realized that she had surprisingly strong negative feelings regarding two women raising a child. She was angry at herself for having these feelings and realized they were pretty entrenched. Arguments she internalized, but never consciously gave any credence to before they made the decision to adopt, ran through her head constantly.

It is difficult for anyone to be completely free of homophobia. Like racism, it insinuates itself into our thoughts and feelings in ways of which we are unaware. But, unlike many other minority groups, gay people, in general, do not share their minority status with their family.

Adoption, Insemination, and Raising Children

The decision to have children, which raises issues for anyone considering parenthood, is more complicated for gay couples. First, there is the decision to have a child and, if so, how? Obviously, this will be something that entails a number of steps. It cannot happen without planning.

A lesbian couple will need to decide on insemination or adoption and consider the following issues.

  • If they choose insemination, they will have to decide who will carry the child?
  • Will they use an anonymous donor or someone they know?
  • If they adopt, there are many decisions to be made as well.
  • Will they adopt a child from another country?
  • Will they go through an adoption agency?
  • Do they want an infant?

There is a great deal of thought and planning that goes into becoming a parent. For gay men, the choices are a little different. Will they adopt? Will they ask someone they know to carry the child that one of them will father? If so, how will this happen?

There are no roadmaps to follow. While this can be enormously freeing, it can also be frightening and confusing. Everyday issues that heterosexuals take for granted can be challenging for gay parents, as the vignette below illustrates:

Mark and Bill, both African-American, are raising a girl they adopted from China. They have grown used to the looks they’ve gotten walking down the street. Bill often wondered if people thought they kidnapped her. They were not prepared, however, for the reaction they received when looking for a qualified pediatrician. They were met with surprise and suspicion by more than one doctor. Not only did they need to find a good pediatrician, they needed to find one that was not homophobic.

Coming Out

Problems can arise when one person in the relationship is not out, as described:

Terry and Gina, both in their early 20’s started to date a little over a year ago. Gina, who lives with her parents, is not out. She comes from a conservative Italian family. Her mother constantly pushes her to find a man and get married. It appears that her parents have no idea that she is a lesbian. She has never introduced Terry to her family. This past fall, the relationship became more serious and Terry approached the subject of living together. Gina became frightened. Not only would it mean separating from her family, but she feared her family’s rejection if they found out she was gay. She felt her mother would be heartbroken to learn that Gina was never going to marry a man. She was terrified to come out to her parents. This caused tremendous conflict within the relationship and the couple were talking about breaking up before they came to treatment.

Family Issues

Family issues can cause stress even when both partners are out. When one partner is not accepted by the other’s parents, choices become limited and limiting.  To illustrate, here is the story of Joan and Mindy.

Joan lived with Mindy for five years. Since her parents live hundreds of miles of away from New York in Baltimore, Joan has been able to maintain her relationship with her mother by not talking about her life very often. Her mother has made it clear that she doesn’t want to hear about their lives together. When Mindy graduated with a PhD, Joan was ecstatic, but also hurt and angry that she couldn’t share it with her own family.

During holidays, Joan was in the position of choosing whether she spends time with her parents or with Mindy. Mindy’s folks live in the city and have always welcomed Joan to their home. Joan feels her mother makes her feel guilty by telling Joan that she should be with them. Joan gave in to her mother’s wishes for the first four years of her relationship with Mindy. But now she wants to be with Mindy and her family. She is tired of trying to get her mother to accept her life and validate her sense of self. Joan is mourning the loss of the family she wished she had. She feels her decision not to spend the holidays with her family will make her relationship with them even more limited.

Sex Roles

When it comes to sex roles, gay couples have an advantage. There is more freedom to choose roles based on individual strengths rather than fighting against traditional stereotypes. There isn’t one person who is “supposed” to support the family, take care of the children, or clean the house. People can be more fully themselves and take on challenges that promote growth for each individual and as a couple as well.

How Couples Therapy Can Help

Often, couples come to treatment with the unspoken hope that therapy will change their partner and, when that happens, their problems will disappear. However, since we can only change ourselves, the work of couple therapy is to recognize our own part in the dysfunctional communication and take steps to improve it.

One of the most important goals of couple therapy is to improve communication. Often, one person is so focused on what to say next that hearing the other person becomes impossible. The argument becomes more about proving that person wrong, than empathizing with the feelings underneath the words.

Shaming, blaming and criticizing rarely bring the desired result. Instead, it can leave one or both partners feeling demeaned, angry, and hurt. Couples who use character assassination when they fight chip away at their partner’s trust and self-esteem. Over time, this will destroy the relationship. In treatment, the couple can gain the tools that will help them communicate productively. Each member can begin to take an honest look at what she/he does to perpetuate problems in communication.

It is very human to become defensive when we are criticized. Our natural instinct is to either withdraw or attack and it isn’t easy to change what feels natural. Having a third person to mediate breaks this cycle. A professional can intervene when the discussion becomes dysfunctional. She or he can facilitate productive communication and create a safer place in which to express feelings. By moving the focus away from “right” and “wrong” and back to the feelings underneath, the couple can gain the tools for effective communication. These tools will help build a stronger and healthier relationship.


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