Lisa Garcia, LMSW, IMH-E™ (III)
Northeast Guidance Center, Detroit, MI
Recently the media has been focused on the subject of gay marriage and marriage equality. For many years there has been controversy about whether gay men and lesbians should be allowed to become foster parents or adopt children. Despite the increase in prevalence of gay/lesbian issues in the media, stigma, homophobia, and discrimination continue to affect the lives of lesbian, gay, bisexual and transgender individuals and their families.
As social workers, infant mental health (IMH) specialists, nurses, and educators, we are less concerned with the controversy of whether gay men and lesbians should or should not be parents. Our focus is, and must be, how to support all families parenting infants and young children. Lesbian, gay, bisexual, and transgender (LGBT) parents/families do exist and we, as clinicians, need to bring sensitivity, warmth, and understanding as we provide services.
The work we do with each parent/family is the same, yet different. This may sound paradoxical but consider that we each approach families from certain theoretical models, knowledge base and skill sets. We bring our own unique personalities, histories and experiences, ethnic and cultural perspectives, and our individual intention to provide services. Although what we bring to each family is the same, the way in which we interact and provide services will be different. The interventions we choose and the focus of treatment will be shaped by the unique needs and nuances of the particular individual or family we are supporting. The same is true for LGBT families. The clinical presentations, stressors, and concerns the parent or child brings to treatment are not unlike any other family; yet there are specific constructs to consider when assessing an LGBT parent or family’s needs.
Considerations for assessment and clinical work with families
Create a welcoming and inclusive environment for all families; Do not assume a parent or child has a traditional/heterosexual family configuration; Be aware of heterosexism in your agency and in your approach to families (assumptions, wording on forms, etc.); Be respectful of the relationships within the family (how they identify); Listen closely to learn about and understand the stresses that impact the members of this family; Use welcoming and inclusive language; and, have pictures of all types of families in your agency (same-sex parents, adoptive parents, single parents, families of color) and display inclusive posters, books, and reading materials.
Questions are an integral part of assessment, but we need to ask ourselves, is my question necessary or am I asking it for my own curiosity? What do I know? What do I need to know? How do I ask this in a sensitive way?
The most critical consideration in clinical work with LGBT families is for the clinician to reflect on his/her own biases and internal dialogue. We may think we are comfortable and open, but we must acknowledge the reality that all individuals hold biases of which they are not aware. If you are not sure how you feel, go to Gay Marriage USA or LGBTQ Nation (or similar site) on Facebook, which has pictures of LGBT couples and families, or go to a Gay Pride parade/festival. Pay close attention to how you feel, not to what you think. Are you comfortable with same-sex couples expressing affection; kissing or holding hands? We owe it to ourselves and to the families we serve to know our biases and comfort zones.
The configuration of LGBT families, like heterosexual families, consists of single parent households, parenting couples, and ex partners who are co-parenting. Many gay parents have biological children from previous marriages or heterosexual relationships. This may be confusing for some clinicians, but is often the result of self-denial, internalized homophobia, an attempt to be “normal”, late coming out, bisexuality, or a strong desire to have children. Therefore, many LGBT families are blended families, often with the same challenges that other blended families face. In other LGBT households, the decision to become a parent is usually intentional. LGBT individuals and couples become parents through insemination, surrogacy, in-vitro, adoption, and/or foster care. As in heterosexual families, the majority of LGBT parents raise confident, emotionally secure, children. There are also families that need support and will present for IMH or other family services.
How does this parent/couple identify themselves and their family? Does the ethnic, racial, religious, or culture of either parent (or their extended family members) impact the couple’s relationship or their views about parenting? If children are foster or adopted, are there racial, ethnic, or cultural issues of the child that impact the parent-child relationship? Does the parent(s) demonstrate the ability to respond to the infant/toddler’s needs with sensitivity and understanding? Does this family have age/developmentally appropriate expectations of their infant or young child? Is there domestic violence, substance abuse, infidelity, or other issues impacting this parent/family? What does each parent prefer to be called by their child (which parent is mom, mommy, dad, daddy, momma, poppa, etc)? How has this parent/family been impacted by social discrimination or homophobia (violation of rights, job loss, hate crimes, etc.)?
There are multiple variables that impact families and some that are unique to LGBT families. The dynamics and/or attachment concerns between a birth parent and the non birth parent can be different in families that choose for one partner to be the biological parent. For example, the role of the non birth parent and how to identify or what to call the other parent can be a challenging decision, or a non birth parent may feel left out/jealous of the biological parent’s relationship with the child. In many States, co-adoptive parents do not have the same legal rights, which may impact the child/parent in many ways, especially in the event of a separation. Many LGBT parents experience the chronic fear of losing their children.
Transgender individuals experience many of the same concerns and discriminations that gays and lesbians experience. However discrimination against an individual based on the expression of their gender identity is referred to as transphobia. One of the significant considerations when working with someone who identifies as transgender is the use of pronouns. Each person will have their own preference for how they choose to be addressed. Some individuals may prefer to use he or she, or prefer the use of a gender neutral pronoun such as “ze”, while others may prefer not to use any pronoun at all. It is important to ask about the use of pronouns, but be sensitive.
How does this individual identify themselves in the broad term of transgender? Has their gender expression impacted their relationship with their children? How does the child and extended family understand the individual? Is the person’s family respectful in their use of pronouns? Are they careful to use pronouns that are aligned with the person’s gender identity and gender expression rather than their assigned gender? Is the transgender person comfortable/accepting of their current expression or identity? What, if any, costs are associated with the individual’s gender identity or gender expression (loss of employment, family, or friends)?
Many transgender individuals are secure and well adjusted in the way they experience themselves and in their gender identity and expression. They have rich and satisfying relationships with their children, partners, spouses, and extended family members. However, those persons who present for treatment, may have endured abuse or negative experiences related to their expression of self.
All LGBT individuals will experience “coming out”. This is a process that typically begins with awareness of, and coming to terms with, one’s sexual orientation. This process can begin at any age and, depending on the balance of self-denial and self-acceptance, can last any length of time. Although gay men tend to be aware of their sexual orientation at an earlier age than lesbians, coming out is a uniquely individualized process that happens in stages. When it happens and how well it happens is influenced by a multitude of variables, including internalized homophobia, the presence of positive/negative role models, ethnicity, culture, religious beliefs, family beliefs, etc. After coming out to oneself, there is the process of deciding whether or not to come out to parents, family members, and friends; and when, where, and how to do that. Each time the person is put into new or unfamiliar situations (new job, school, or neighborhood), they may need to come out all over again. Coming out is a lifetime process.
Where is the parent in their coming out process? Where is their partner in their own process? Were their experiences of coming out supportive/uplifting or alienating? Have they been rejected by family members or lost friendships? How is the baby/children regarded by extended family, if the child was adopted? Does the baby/child enjoy relationships with the non birth parent or partner’s family members? Does the parent experience extended family/friend relationships? Do the parents have connections or involvement in the LGBTQ community?
Many gay and lesbian headed families enjoy rich relationships with family and friends. Some create their own families and natural supports within the LGBTQ community. However, negative coming out experiences and a lack of support can contribute to isolation and impact the family. Also, if one partner is open or “out” and the other is “closeted”, this can place a great deal of stress and strain on the couple’s relationship. We know that parental stress and isolation can negatively affect the parent-child relationship and place risks to an infant or toddler’s attachment.
LGBT families, like other minorities, are burdened by the influences of social stigma, oppression, and discrimination. Systematic homophobia perpetuates myths, bias, stereotypes, and inequalities that permeate across the lifespan. LGBT individuals and families are personally affected by a lack of positive gay parent role models and negative messages about their ability and right to parent. Internalized homophobia is a damaging outcome that can influence a person’s ability to form a healthy identity and sense of self, and can ultimately interfere with their ability to form secure relationships with others, including their children.
The inability for same-sex parents to marry or have their relationships legally recognized can have far reaching implications for LGBT couples, parents, and families. Parental rights are affected. A non-biological same-sex co-parent does not have any legal rights to their child(ren), including medical or educational rights. Even in cases where a co-parent has adopted, they may not be recognized as a legal parent. A non legal parent can be prevented from attending their child’s school functions, visiting their child in the hospital, getting medical care for their child, and has no parental protections in the event of a separation. This has far reaching implications for attachment and parent-child relationships.
The differences between same-sex and heterosexual couples are not in the quality of their parenting but in society’s response to their families.
An IMH Story:
A single lesbian mother sought infant mental health services because she had adopted the biological child of her ex partner, before they separated, and was ambivalent about caring for her ex partner’s subsequent children.. The ex partner was abusing substances and became pregnant. She continued using drugs during her pregnancy and gave birth to twins who were exposed to cocaine. She was homeless and continued using drugs as she attempted to care for her infants. The mother overdosed in a crack house and her infants were found with her. They had their names and her ex’s phone number pinned to their coats. The twins were placed with the ex partner, who had adopted the older brother.
This mother needed support to cope with the death of her ex, and her feelings of anger and ambivalence. She felt trapped by her desire to “do what was right” and she was angry that the babies were neglected and prenatally exposed. She feared she would not be able to care for the babies’ special needs and the three year old she had adopted.
This single mother and her children received services from an IMH specialist who met this family with openness and did not make judgments about sexual orientation, how the children came into the family, the mother’s feelings of confusion/ambivalence, or the biological mother’s drug use. The family received IMH interventions of parent-infant psychotherapy, developmental guidance, advocacy, emotional support, and case management services to address concrete needs. During treatment, the mother revealed a history of physical and emotional abuse during her childhood and the early death of her own mother. These were some of the issues that challenged this family’s ability to form secure attachments
The IMH therapist held and nurtured this overwhelmed young mother; helping her to experience trust through the therapeutic relationship and to learn what each of her children needed from her to begin to trust and become secure. This family received home-based services for two and a half years. The mother was able to support each child’s physical development and learned to be more responsive to their social-emotional needs. Before services ended, this mother legally adopted the twins.
• See American Psychological Association. Lesbian and Gay Parenting: A Resource for Psychologists, District of Columbia, 1995; Child Welfare League of America, Issues in Gay and Lesbian Adoption: Proceedings of the Fourth Annual Peirce-Warwick Adoption Symposium, District of Columbia, 1995.
• Petit, M. & Curtis, P., Child Abuse and Neglect: A Look at the States, 1997 CWLA Stat Book, Child Welfare League of America, Washington, D.C., 1997, p. 72, 124.
• Petit, supra note 2.
• Sokoloff, B., "Antecedents of American Adoption," The Future of Children. Vol. 3, No. 1 (1993), pp. 17-26; Cole, E. & Donley, K., "History, Values, and Placement Policy Issues In Adoption," in The Psychology of Adoption. Eds. David Brodzinsky & Marshall Schecter, (New York: Oxford University Press, 1990), pp. 273-294.
• Human Rights Campaign Family Project (National) http://www.hrc.org/issues/8399.htm http://www.hrc.org/documents/parenting_laws_maps.pdf http://www.hrc.org/documents/gayandlesbianfamilies.pdf
• Coalition for Adoption Rights Equality, Inc (Michigan) http://www.secondparentadoption.org/ http://www.secondparentadoption.org/library/researchmenu.htm
• Rainbow Sauce – Children’s Books for LGBT Parents http://www.rainbowsauce.com
• American Civil Liberties Union (National) http://www.aclu.org/lgbt/parenting
• American Psychological Association (Research on LGBT parents/families)
• Proud Parenting http//:www.proudparenting.com
• Gay and Lesbian Adoptive Parents: Resources for Professionals and Parents http://naic.acf.hhs.gov
• All Children Matter: How Legal and Social Inequalities Hurt LGBT Families http://action.familyequality.org/site/PageServer?pagename=AllChildren
• Lambda Legal Defense Fund (National) www.lambdalegal.org
• PFLAG (National and local) www.pflag.org
• Family Pride Coalition www.FamilyPride.org
• American Civil Liberties Union (National/MI) www.aclu.org
• Affirmations LGBT Community Center (Michigan) www.goaffirmations.org
• Triangle Foundation (Michigan) www.tri.org
• Ruth Ellis Center (Michigan) www.ruthelliscenter.com
• Lesbian Mom’s Network (Michigan Parent Support) www.lmnetwork.org
• National Adoption Information Clearinghouse 330 C St., SW Washington, DC 20447 (888) 251-0075 or (703) 352-3488 http//,firstname.lastname@example.org http://naic.acf.hhs.gov
• Gay Parenting Complete Guide for Same-Sex Families by Shana Priwer and Cynthia Phillips
• Gay Men Choosing Parenthood by Gerald P. Mallon
• Loving Someone Gay by Don Clark, Ph.D
• For Lesbian Parents by Suzanne Johnson & Elizabeth O’Connor
• LGBT-Parent Families: Innovations in Research and Implications for Practice edited by Abbie E. Goldberg and Katherine R, Allen
• Lesbian and Gay Parents and Their Children: Research on the Family by Abbie E. Goldberg
• Prejudice to Pride: Moving from Homophobia to Acceptance by Ann Marie Petrocelli