Families in Flux: A Therapist's Perspective On Gay and Lesbian Couples and Families

By Bruce Koff

This is a transcript of an address delivered on November 11, 2005 at the annual conference of the Family Institute of Northwestern University, Evanston, Illinois.

I am delighted to be here and am very grateful to the Family Institute for incorporating into this conference an opportunity to consider the diversity and, therefore, increasing complexity of family life in the 21st century. As I was asked to speak about lesbian and gay couples and families, I should start by telling you that I'm married, which isn't very interesting, except that I'm married to a man, Mitchell, which I suppose makes my being married a bit more interesting. In November of 2003, I read in the N.Y. Times of a gay male couple in their 80's who'd been together over 50 years and decided to go to Toronto and get legally married --- that is, legally within Canada. Having been with Mitchell for 21 years, I thought to myself, "I'll be damned if I'm gonna wait another 30 years to get married!" So, I came home that evening, got down on one knee, and proposed to my sweet man. "Mitch," I said, anticipating the upcoming Presidential election and the growing gay marriage controversy, "2004 is going to be rough on us. Let's get as married as we possibly can! Screw the Radical Right!" --- Not the most romantic proposal, I suppose, but ... my sweetheart said "YES!". Three weeks later our best friends joined us on a trip to Vancouver where, through both civil and religious ceremonies, we got hitched. Marriage, for us, was not about making a deeper commitment. After 21 years, we were in no need of that. Nope... getting married was just one more strategy for coping in a hostile world --- one more terribly therapeutic, resilient, strengths-based response --- and it helps.

Gay marriage and gay families draw attention these days as our society debates the rights of two people of the same sex who love each other to obtain the substantial legal benefits of marriage; the rights of children to be adopted and loved by adults regardless of a parent's sexual orientation; the rights of parents to have children and raise the children they have regardless of the parents' sexual orientation, and the right of lesbian and gay families to live without fear of discrimination, harassment, or abuse. It's a strange world we live in now when we reduce all of that to the term "culture war," as if the experience of being denied access to your partner in a hospital; denied custody of your children; or denied a partner's social security benefits in the event of that partner's death is no more significant than your taste in music. This is no more about culture than sexual orientation is about "lifestyle." This is about living as second-class citizens, and living in fear.

Gay and lesbian families, of course, despite their current newsworthiness, have always existed in this country. Lesbians and gay men have formed committed relationships, had and raised children, and forged new family forms that have sustained us throughout history. Only recently has the U.S. census sought information on same-sex households, which I will share with you. A caveat, of course: these numbers reflect only those individuals who were willing to tell the government they were in a same-sex relationship; chances are this is but a fraction of the actual numbers. That being said, the U.S. Census reports approximately 600,000 same-sex couples in U.S. The census further reports that 219,134 persons who consider themselves Black or African/American are in a same-sex couple, (18.7% of lesbians in female couples, and 18.1% of gay men in male couples). A more recent study conducted by the NGLTF Policy Institute reported there are more than 100,000 Hispanic same-sex households in the US, and 2/3 of such couples in which both partners are Hispanic are raising children. Nearly half of individuals in same-sex relationships in which both partners are Hispanic are not U.S. citizens and, because of the lack of legal marriage, are not entitled to immigration rights obtained through marriage. Finally, the U.S. Census reports that 97.6% of all census tracts with a household population have same-sex couples (we're everywhere), and that 34% of lesbian couple households and 22.3% of male couples have children. Finally, according to the U.S. Census, 415,970 children live with same-sex couples.

So although our relationships may be news, they are not, in fact, new. Legal marriage for same-sex couples is, however, quite new, as are the constitutional bans on same sex marriage that various states have now passed! Now, and for the foreseeable future, lesbians and gay men will live in a nation with a patchwork quilt of laws and regulations regarding same-sex relationships. In a handful of states, our relationships are recognized and given some legal status, Illinois not among them. In most other states, we are outlaws, living in committed relationships without legal support or benefits. At a national level, we can anticipate that our lives will continue to be grist for political discourse and leverage for getting out the vote among the radical Right.

This fact of existence for lesbians and gay men is of great consequence. Having been "out" for 33 years, I look back and, of course, see great progress. At age 19, I had to face immense fear with few resources. My vision of a future as a gay man was murky at best: No thought of legal marriage, no notion of how a gay man might be in a same-sex relationship, much less have children, no map for how families adapt to integrating it's gay or lesbian members. What I experienced was immense and almost insurmountable fear.

Now, gay or lesbian teens confront a very different world. Resources abound on the internet, TV shows swell with gay and lesbian characters and personalities, over 3000 schools host gay/straight alliances, and gay marriage is legal in Massachusetts, Canada, Spain, The Netherlands, Denmark, and Norway, with others swiftly approaching this watershed. Yet, as one young adult shared with me recently, 2004 was the most frightening year of his life. For despite what I regard as the sweep of immense progress, he witnessed primarily the virulent rantings and ravings about gay marriage. The torrent of condemnation and stereotype, amplified through Fox News, Republican-led campaigns for so-called "marriage amendments," and religious presence on the airwaves, created in him a terror that, subjectively, was no less extreme than what I felt in 1972. As therapists, we risk irrelevance should we underestimate the effect such bigoted discourse has on lesbians, gay men, their parents and their children.

What is also true is that, for better or worse, lesbians and gay men have always sought help from mental health professionals. As we assist this population in forming and maintaining healthy relationships and families, we cannot assume that there is no difference between same-sex relationships and opposite-sex ones. Differences abound, and they require considering not only a different approach with our gay and lesbian clients, but a different role for us as therapists as well.

The questions we might consider are numerous and daunting. How are gay and lesbian households different from and the same as heterosexual households? In addition, how might we understand the dynamics in a lesbian couple relationship and a gay male relationship differently than we might understand those in heterosexual relationships? How do variations of race, ethnicity or culture affect these dynamics? For example, how might an African-American man whose primary or sole source of privilege in our society resides in heterosexual identity surrender that privilege for the love of another man? How will such a choice impact his sense of well being and the relationship he forms? How do lesbians and gay men define family differently from heterosexual persons? How do laws that deny the right of lesbians and gay men to marry or adopt affect their relationships with each other, with their children, with their families of origin? How might our own biases interfere with our work with lesbians and gay men and their families? How do we define "competence" in clinical practice with this population, and how do we translate that definition of competence into quality training? What role do we as clinicians have in raising these issues with our colleagues, our agency, school or hospital administrators whom we know could do better? Finally, do we as a society have something to learn from the relational experiences of lesbian and gay men? Do same-sex relationships offer guidance for heterosexual relationships, particularly as the gender-bound divisions of power, labor and responsibility shift so profoundly?

The gay and lesbian population is immensely diverse, but let me offer a brief survey of some of the more substantive differences between gay and straight relationships, beginning with the notion of "family." It is not uncommon for lesbians and gay men to form familial relationships quite outside of blood ties, for the simple reason that so many are alienated from families of origin. During the early years of the AIDS epidemic, for example, it was not unusual to see the deaths of gay men to the disease memorialized with a funeral by the blood-related family and a separate memorial service attended by the predominantly gay family of close friends. An assessment of a lesbian or gay man's family life may require us to consider that the effects of a "cut-off" with families of origin may be quite ameliorated by deep, familial connections with others.

In addition, lesbians and gay men who lack the cultural support for their relationships obtained through rituals, customs and celebrations of milestones must invent them. This is part of the larger challenge to same-sex couples to create a deep sense of couplehood despite a lack of mirroring and recognition from others. Couples may initially struggle with matters about which heterosexually married couples would never think twice, such as what to call each other, how to introduce each other to family or work colleagues one might encounter, whether or not to hold hands or greet each other with a kiss in public, what to celebrate as an anniversary, whether or not to spend holidays together or with their respective families, or whether or not to sleep in the same bed at Mom and Dad's house. Other concerns that might require solutions that deviate from the norm for heterosexual married couples might include how to protect each other in the event of illness, how to manage money, or even how to find support when the relationship falters. Parents, for example, may be delighted to learn that their daughter has ended a lesbian relationship in the hope that it was all just a phase. All of these concerns and potential indignities chip away at the very integrity of the relationship, and gay and lesbian couples, and their therapists, are challenged to remain vigilant toward the insidious effects of these experiences.

Children in gay or lesbian households must also master this extra set of challenges, especially around disclosure or the failure of others to recognize the legitimacy of the relationship between their parents. Disclosure and integration of difference around the circumstances of one's birth, such as surrogacy, alternative insemination or adoption are additional factors to consider.

Therapists would also do well to remember that, although an increasing number of lesbians and gay teenagers have the opportunity to experience a more safe and normative adolescence in which the developmental milestones associated with that age are obtained through same-sex dating and healthy integration of a core identity, the majority continue to find that process thwarted by fear and truncated until adulthood. Consequently, lesbians and gay men initially experience a resurgent adolescence as adults and may be prone to form commitments precipitously, or otherwise exhibit relational behaviors characteristic of adolescent development.

All lesbians and gay men also come into adulthood having experienced an extra-developmental event; learning to manage a stigmatized identity. Based on the extent and pervasiveness of real or imagined threats associated with what Goffman called the "discreditable identity," lesbians and gay men develop strategies to defend against harassment, ostracism, abuse or loss. These strategies, tied to one's essential desire for safety, can become pervasive and strongly influence the formation and course of adult relationships. Therapists must learn to assess these strategies and their impact. A strengths-based approach might also consider how the committed relationship between two men or two women provides a unique opportunity to heal the wounds derived from traumatic childhood experiences associated with stigma.

Therapists who work with this population must also consider how gender role socialization, combined with expectations derived from gay male and lesbian subcultures, may affect how same-sex couples approach conflict and power differently than heterosexual couples do, and how we may structure distance and closeness differently. Contemporary research indicates that same-sex relationships offer helpful models of shared decision-making not bound by traditional gender role expectations.

And of course, understandings about sex and love may contrast sharply with those of heterosexual couples. For example, the history of the criminalization of sexual activity between men and the subsequent emergence of gay liberation fostered the institutionalization of liberationist norms around sexual behavior between men -- in particular, that sex between men can be joyous, celebratory and transforming and that it need not be seen as a threat to a primary relationship. Consequently, although many gay male couples are monogamous, a fair percentage are not. (lesbian couples least likely). We err if we conflate relational health among gay men with monogamy. Some gay male couples view their choice to open their relationship as a function of closeness, trust, and intimacy. Our challenge as therapists working with this population is to define what healthy non-monogamy in a gay male relationship looks like, or for that matter, what unhealthy monogamy looks like as well.

Similarly, we may err when we apply Bowenian notions of closeness and differentiation to the characteristics of relationships between women, conflating caring, nurturing, consistency and openness of communication with pathological fusion. This is particularly disturbing when research suggests that lesbian couples report higher levels of satisfaction in their relationships than either heterosexual or gay male couples!

While this is just a brief survey of potential differences between same-sex and opposite- sex relationships, it implies some variation in our role as clinicians as well. Because gay and lesbian couples and families are not afforded equal rights in this country and often remain alienated and stigmatized, we are compelled to attend to the effects of this. The core question to ask is, "As a heterosexual, would I accept the conditions under which this family or couple must live? How might this affect me and my relationship? What would I be teaching my children were I to accept without question such second-class status?" I presume that our answer to these questions leads us to become more empathic and proactive, to advocate at times, and to surrender neutrality that only reinforces that diminished status. Cheryl Rampage addresses this in terms of challenging sexism in her article "Marriage in The 21st Century: A Feminist Perspective," stating "neutrality is implicitly supportive of the status quo, which in a sexist society, means that neutrality is inherently a pro-sexist position." Similarly, we as mental health professionals cannot be neutral about gay relationships in a homophobic culture, as neutrality in this case is inherently homophobic. When we take a "pro-commitment" stance clinically, we take a "pro-commitment" stance politically.

It is daunting to define competency in clinical practice with such a complex and diverse population. Though it may always be a little beyond our reach, let us as least ask a new set of questions, add an extra component to our assessments, and challenge our assumptions and biases at every turn. To the extent that we, as mental health professionals, understand the unique experience of living as a gay or lesbian person in America and how this experience interacts with race, ethnicity and culture, to the extent that we learn how lesbians and gay men develop, mature and form relationships in the face of adversity and acknowledge how these can constitute significant differences between same-sex and opposite sex couples, and to the extent that we accept the importance of advocacy in our work, we become competent.

Thank-you.