Parenting lgbt youth
- Similar articles in PubMed
- Clinical Implications
- Implications for Parent-Child Attachment
- Parental Reactions to Youths’ LGBT Disclosure
- LGBT Youth and Family Acceptance
- Theories of Parental Acceptance and Rejection
- Parental Reactions to Gender Nonconformity
Similar articles in PubMed
The Institute of Medicine recently concluded that LGBT youth are at elevated risk for poor mental and physical health compared with heterosexual and cisgender peers.2 Indeed, representative samples of youth have found disparities by sexual orientation in health-related risk behaviors, symptomatology, and diagnoses, 3–8 with disparities persisting over time.9–11 Furthermore, sexual orientation disparities exist regardless how sexual orientation is defined, whether by sexual or romantic attractions; sexual behaviors; self-identification as heterosexual, bisexual, lesbian/gay or other identities; or, any combination thereof. Disparities by gender identity have also been found, with transgender youth experiencing poorer mental health than cisgender youth.12
In this article, we address theories of attachment and parental acceptance and rejection, and their implications for lesbian, gay, bisexual, and transgender (LGBT) youths’ identity and health. We also provide two clinical cases to illustrate the process of family acceptance of a transgender youth and a gender nonconforming youth who was neither a sexual minority nor transgender. Clinical implications of family acceptance and rejection of LGBT youth are discussed.
The vast majority of sexual minority youth are born to heterosexual parents. Those parents may not uncommonly possess implicit or explicit negative attitudes toward homosexuality and expect their children to be heterosexual. Parents may not only be surprised that their child may be or is a sexual minority, but they may also respond negatively to the child. Similarly, the vast majority of transgender and/or gender nonconforming youth are born to cisgender and/or gender conforming parents, who often possess negative attitudes toward those who violate societal expectations for gender identity, expression, and roles, and expect their children to be cisgender and gender conforming. Negative responses from parents to LGBT youth may range from anxious concerns about the child’s well-being and future to abuse and even banishment of the child from the home.
Actual or anticipated family acceptance or rejection of LGBT youth is important in understanding the youth’s experience of minority stress, how the youth is likely to cope with the stress, and consequently, the impact of minority stress on the youth’s health.19 This article addresses the role of family, in particular parental acceptance and rejection in LGBT youths’ identity and health. Literature reviewed in this article focuses on the experiences of sexual minority cisgender youth due to a lack of research on transgender youth. However, we include findings and implications for transgender youth whenever possible.
Implications for Parent-Child Attachment
According to Bowlby,20–22 attachment to the primary caretaker guarantees survival because the attachment system is activated during stress and concerns the accessibility and responsiveness of the attachment figure to the child’s distress and potential danger. The pattern or style of attachment that develops is based on repeated interactions or transactions with the primary caregiver during infancy and childhood. Those experiences, in interaction with constitutional factors like temperament, influence the internal working model (i.e., mental representations of emotion, behavior, and thought) of beliefs about and expectations concerning the accessibility and responsiveness of the attachment figure. In time, this internal working model influences perception of others, significantly influencing patterns in relationships over time and across settings. The beliefs and expectations concerning the attachment figure also affect the internal working model of the self, meaning the individual’s sense of self-worth.
The three consistent patterns of attachment that arise in infancy and childhood are related to the internal working models of the self and other. The “secure” child has positive models of the self and other because the primary attachment figure has been accessible when needed and responsive in an attuned and sensitive manner to the child’s needs and capabilities. Consequently, the securely attached child is able to regulate emotion, explore the environment, and become self-reliant in an age-appropriate manner. The “insecure” child has an inaccessible and unresponsive primary caregiver, who is intrusive, erratic or abusive. One of two insecure attachment patterns emerges. In the first pattern, the child dismisses or avoids the parent, becoming “compulsively”21 self-reliant and regulating emotion even when contraindicated. This child with “avoidant/dismissive” attachment depends on the self, possessing a positive internal working model of the self but a negative one of the other. In the second insecure attachment pattern, the child is anxiously preoccupied with the caregiver but in a resistant (i.e., distressed or aroused) manner. The individual with “anxious/preoccupied/resistant/ambivalent” attachment has a negative working model of the self, but a positive model of the other.
Parental Reactions to Youths’ LGBT Disclosure
Attachment patterns in childhood are partly related to character traits in adulthood, and have implications for emotion regulation from the perspective of coping with stress, as detailed elsewhere.23,24 Based on positive working models of the self and other, the securely attached individual approaches a stressful situation in an adaptive manner that allows for a realistic appraisal of the situation and a selection of coping strategies most likely to reduce or eliminate the stressor or, at minimum, render the stressor tolerable. By comparison, insecurely attached individuals may distort reality because they may be more likely to appraise a situation as stressful even when it is not. They may also be maladaptive in their management of stress and use emotion-focused coping strategies, such as substance use, to improve mood and tolerate stress. These patterns of coping influenced by attachment are present by and common in adolescence.25 Coping is critical because sexual orientation and gender development are potentially stressful experiences for all youth, but especially for sexual and gender minorities, given the frequent stigmatization of homosexuality, gender non-conforming behavior, and gender-variant identities.19
In this article, we discuss sexual minority, i.e., lesbian, gay, and bisexual (LGB) and transgender (LGBT) youth. Sexual orientation refers to the individual’s object of sexual or romantic attraction or desire, whether of the same or other sex relative to the individual’s sex,1 with sexual minority individuals having a sexual orientation that is partly or exclusively focused on the same sex. Transgender refers to individuals for whom current gender identity and sex assigned at birth are not concordant, whereas cisgender refers to individuals for whom current gender identity is congruent with sex assigned at birth.1,2 Sexual orientation and gender identity are distinct aspects of the self. Transgender individuals may or may not be sexual minorities, and vice versa. Little is known about transgender youth, although some of the psychosocial experiences of cisgender sexual minority youth may generalize to this population.
LGBT Youth and Family Acceptance
Attempts have been made to understand sexual orientation and gender identity-related health disparities among youth. It has been argued that sexual minority youth experience stress associated with society’s stigmatization of homosexuality and of anyone perceived to be homosexual [see Ch. 5]. This “gay-related”13 or “minority” stress14 is experienced at the hands of others as victimization. It is also internalized, such that sexual minorities victimize the self by means, for example, of possessing negative attitudes toward homosexuality, known as internalized homonegativity or homophobia. In addition to interpersonal stigma and internalized stigma, the main focus of this article, structural stigma reflected in societal level norms, policies and laws also plays a significant role in sexual minority stress, and is discussed in Mark Hatzenbeuhler’s article, “Clinical Implications of Stigma, Minority Stress, and Resilience as Predictors of Health and Mental Health Outcomes,” in this issue. Meta-analytic reviews find that sexual minorities experience more stress relative to heterosexuals, as well as unique stressors.6,15,16 Research also indicates that transgender individuals experience substantial amounts of prejudice, discrimination, and victimization17 and are thought to experience a similar process of minority stress as experienced by sexual minorities,18 although minority stress for transgender individuals is based on stigma related to gender identity rather than stigma related to having a minority sexual orientation. Stigma related to gender expression affects those with gender non-conforming behavior, a group that includes both transgender and cisgender individuals. This includes many cisgender youth growing up with LGB orientations.
LGBTQ Parents Children of LGBT Parents, COLAGE Boston Fenway Health LGBT Family & Parenting Services Gay Fathers of Greater Boston Human Rights Campaign/Parenting Issues LGBTQ Youth - Greater Boston Boston Alliance of Gay, Lesbian, Bisexual & Transgender Youth (BAGLY) Boston GLASS Community Center Bullying and Gay Youth Gay, Lesbian and Straight Education Network (GLSEN) GLBTQ Domestic Violence Project OUT MetroWest, resources for GLBTQ youth, their families and others Peer Listening Line, 800-399-PEER Suicide Prevention/The Trevor Project The Network/La Red: Ending abuse in lesbian, bisexual and transgender communities The Triangle Program at Arbour-HRI Hospital LGBTQ Youth - Western MA Generation Q and TREE Community Action Youth Programs Out Now Advocacy and Support for All Parents Family Acceptance Project Family Equality Council Greater Boston Parents, Families & Friends of Lesbians and Gays (PFLAG) Massachusetts Transgender Political Coalition National Center for Transgender Equality OUT MetroWest, resources for GLBTQ youth, their families and others Supportive Families, Healthy Children: Helping Families with Lesbian, Gay, Bisexual & Transgender Children Supporting and Caring for Transgender Children The Massachusetts Commission on GLBT Youth Trans Youth Equality Foundation Transgender Children and Youth Faith Community Parent Support Dignity Boston Eshel Fortunate Families Gay Christian Network JQ Helpline Keshet Resources for Faith Communities