Clinical Considerations in Working with Clients in the Coming Out Process

Abstract

Mandel (2014) describes the conceptualization, assessment, and treatment of "Adam," a hybrid client presenting with depression, cannabis abuse, perfectionism, and distress related to his sexual orientation, which appeared to be fueling these psychological problems. In this commentary, we examine theoretical and clinical issues raised by this case regarding clients’ experiences with coming out. Drawing on the case and pertinent research, we highlight clinical challenges involved in helping clients navigate issues of identity development and intersection, interpersonal disclosure, internalized homophobia, and community connectedness. We present specific strategies for tailoring interventions to the diverse experiences and needs of sexual minority clients. Throughout the commentary, we reflect on potential intrapersonal, interpersonal, and systemic processes that may impact clients’ identity integration and psychological well-being.

Risking It Anyway: An Adolescent Case Study of Trauma, Sexual and Gender Identities, and Relationality

“…Thus, one of my early tasks with Jae was to work to bracket my biases and strive to use Rogers’s (1975) accurate empathy to understand Jae’s experience from her perspective . This approach is consistent with evidence on best practices for SGM clients, which underscores the importance of unconditional positive regard and creating a safe environment early on and links the quality of the therapeutic relationship with positive therapy outcomes (APA, 2012; Chazin & Klugman, 2014; Israel et al, 2008; Mandel, 2014; Richmond et al, 2012). As a feminist therapist and a community psychologist, I work to attend to issues of power and identity inside and outside of the therapy room, recognize the impacts of ecological systems on clients’ well-being, and highlight clients’ strengths.…”

“…Creating a safe environment is a crucial part of the initial groundwork of affirming therapy with SGM clients. Unconditional positive regard is particularly important to developing the strong therapeutic relationship that is important for effective therapy with SGM clients (Chazin & Klugman, 2014; Israel et al, 2008; Mandel, 2014). Affirmation of SGM identities can be communicated in multiple ways, including institutional forms, language, avoiding assumptions about someone’s identities, or pronouns, and explicitly stating a commitment to addressing the harm caused by systems of oppression (Richmond et al, 2012; Singh & McKleory, 2011).…”

“…For many SGM people, particularly those with multiple marginalized identities, navigating multiple cultural worlds means that identity development is an ongoing process balancing authenticity and necessity. Clinicians should recognize and respect these complex identity management processes in order to avoid pressuring clients to conform to a particular model of identity development and disclosure and to hold space for ambiguity and change (Chazin & Klugman, 2014; Levitt & Ippolito, 2014; Minshew, 2015).…”

An overview of coming out research: Introducing a three‐lens typology

“…Related to stigma, discrimination, and (mental) health consequences for LGBTQ+ individuals, a considerable amount of coming out research focussed on how counsellors and therapists can support the coming out process of their LGBTQ+ patients and clients (e.g., Ali & Lambie, 2019; Bennett & Donatone, 2020; Boe et al., 2018; Chazin & Klugman, 2014; Clarke, 2007; Matthews & Salazar, 2012; McGeough, 2020; Morrow, 2001; Solomon et al., 2018) and how they can help families with navigating relationships and dynamics after the coming out of a LGBTQ+ family member (e.g., Lasala, 2000; O’Neill et al., 2019; Saltzburg, 2007; Tanner & Lyness, 2004).…”

Like a Chameleon: Resilience among Self-Identified Latinx Mixed Adults

“…Since earlier writings on identity (e.g., Cross, 1995;Kim, 2001;Sue & Sue, 1990) it has been known that a multicultural orientation in psychotherapy includes recognizing and potentially discussing salience for clients of particular identities at particular times (Yakushko et al, 2009). The now burgeoning literature on intersectionality emphasizes open dialogue in psychotherapy and avoidance of specific labeling (American Psychological Association, 2003;Chazin & Klugman, 2014). Furthermore, this literature underscores the importance of recognizing and conceptualizing multiple identities.…”