This is an excerpt from my latest book, "Gay Affirmative Therapy For The Straight Clinician: The Essential Guide published by WW Norton in March, 2008
We do not choose to be gay . . . we are chosen.
- Suzanne Westenhoefer, lesbian comic
Most people don't realize that the coming out process has predictable, observable stages. Once you become familiar with the stages, you can know which one the lesbian or gay person is in-and what they can anticipate.
The stages do not necessarily occur in order. Lesbians and gays may jump back and forth, skip one or two, or linger in some as well. Some linger at one stage longer than others. It may be years before they move on.
Various theorists have developed and defined the stages of coming out and discussed how clinicians can use them as a framework and tool for clients. By discerning which stage a client is going through, you can best prepare him or her for the next one.
Vivienne C. Cass's Homosexuality Identity Formation model (Cass, 1979) best reflects the stages I've observed in my clients. According to her, the stages of identity formation are:
Stage 1: Identity Confusion
Stage 2: Identity Comparison
Stage 3: Identity Tolerance
Stage 4: Identity Acceptance
Stage 5: Identity Pride
Stage 6: Identity Synthesis
These stages are not necessarily linear or consecutive. Many individuals go from stage 1 to 3 and back to 1, depending on many factors, such as their personality and the circumstances in their lives.
During the first three stages, clients are most at risk for stopping the coming out process and regressing back into the closet. These are the most vulnerable stages in that clients' emotions are raw and their sensitivity to judgments of others is high. Safety, both emotional and physical, is crucial during these early stages. The work during these stages is often internal in that lesbians and gays are mentally and emotionally deciding within themselves what their identity is, comparing themselves to others, and deciding whether or not they can tolerate it. It is also important to start and stop the coming out process at their own pace.
The final three stages are more affirmative, as clients become increasingly certain that they are on the right track and can accept and claim their authentic gay identities. The work is more outwardly focused; clients venture out into the gay and lesbian world and begin learning relational and socialization skills that help them become more social and intimate with other gays and lesbians. Therapists need to assess what is creating any difficulties or snags for their clients during this time and watch for any developmental injuries such as issues pertaining to a dysfunctional family of origin or repressed memories of abuse. Depression and anxiety may also surface and interfere with the coming out process.
Stage 1. Identity Confusion
Those who begin to acknowledge their attraction to other members of the same sex may not see themselves as even remotely gay. This isn't pretending; they still honestly identify themselves as heterosexual. At this stage, their homosexual feelings are completely unacceptable to them. They are looking for anyone who might tell them they are not gay.
Men may have sex with other men but define it as something other than gay or bisexual behavior. Terms like "on the down low" and "kinky" can help a man stay closeted to himself. Women might be sexual with other women and consider it merely experimental, or they may think of having sex with another woman as something for their male partner and his desires-not theirs. For many people, that may be true. For others it is the beginning of a natural gay or lesbian identity surfacing.
Once individuals recognize that a homosexual nature does exist within them, they often become very sensitive, highly anxious, and self-conscious. This is the beginning of reexperiencing their PTSD symptoms. Pushing them too far in this stage can cause too much psychological discomfort and potentially keep them from moving on to the next stage.
Many clients at this stage do not use the word gay or lesbian, as it would reflect affirmation and positivity. If anything, they'll usually self-identify as "homosexual" or "heterosexual with homosexual fantasies." Therapists need to stick with their clients' terminology to avoid rushing them or blocking them from continuing with their process..
At this stage, clients are ready to seek information, often by logging onto the Internet to explore various websites about homosexuality. They are also vulnerable to getting married heterosexually, genuinely hoping for the best. Your job here is to support clients in being honest and open with their potential opposite-gender mates about their homosexual urges, thoughts, or feelings so that their potential partners can have informed consent.
When clients enter your office in this stage of coming out it is an opportunity to intervene and help them identify and understand the true nature of their sexuality.
Stage 2. Identity Comparison
During this stage, clients begin to accept the possibility that they might be homosexual. They still typically don't describe themselves as "gay," because they associate the word with a particular way of life. The word homosexual lets them start exploring from a "safe" distance.
Some clients may accept their behavior as gay or bisexual while still rejecting homosexuality as their core identity. Or they might accept a homosexual identity but, paradoxically, inhibit their gay behavior by, for example, deciding to heterosexually marry and have anonymous "no strings" sexual hookups. Of course, this kind of compartmentalization-a fracturing of behavior and identity-leads to problems later on.
Some lesbian and gay clients may attempt to embrace a heterosexual identity out of internalized shame and guilt. These clients are particularly vulnerable to the promises of reparative therapy. Because of their self-hate and hope for a "cure," they are eager to be rid of these unwelcome thoughts and feelings.
Other clients, after exploring and experimenting, may decide to pursue a heterosexual life but do so not out of shame or guilt-they simply don't connect to a gay identity. Just like adults raised in one organized religion who decide to convert to another, they're entitled to choose the identity that fits them best. They don't change orientations; they change how they live out their identity. In other words, they are still inherently gay or lesbian, but they self-identify as heterosexual and decide to live this way.
When treating clients in this stage, it is important that psychotherapists (particularly gay and lesbian therapists) not force the issue of whether their client is gay, straight, or bisexual, as doing so can cause damage. Again, I cannot stress enough that it must be the client who leads the way during these early stages, with you helping in the background.
Stage 3. Identity Tolerance
At this stage, individuals accept the likelihood that they're homosexual in a positive way and begin to move toward describing themselves as gay or lesbian. This entails "trying on" a homosexual identity to see if it fits. Clients may still hesitate to venture into the gay culture, but they do begin to see a need to end their social isolation and loneliness.
Clients' experiences moving toward homosocialization within the gay and lesbian community have a significant impact on the rest of their coming out process. If the experiences are positive, the individual will continue moving forward in the coming out process and begin an affirmative identity. If they are negative, the individual might stall or revert to stages 1 or 2.
