28 jOURNAL Of MULTICULTURAL COUNSELING AND DEVELOpMENT • Janua.docx

28 jOURNAL Of MULTICULTURAL COUNSELING AND
DEVELOpMENT • January 2016 • Vol. 44
© 2016 American Counseling Association. All rights reserved.
Received 06/29/15
Revised 07/20/15
Accepted 07/21/15
DOI: 10.1002/jmcd.12035
Multicultural and Social Justice
Counseling Competencies:
Guidelines for the Counseling Profession
Manivong J. Ratts, Anneliese A. Singh, Sylvia
Nassar-McMillan,
S. Kent Butler, and Julian Rafferty McCullough
In 2014, the Association for Multicultural Counseling and
Development (AMCD)
appointed a committee to revise the Multicultural Counseling
Competencies
developed by Sue, Arredondo, and McDavis in 1992 and
operationalized by
Arredondo et al. in 1996. This article reflects the updated
competencies, titled
the Multicultural and Social Justice Counseling Competencies
(MSJCC; Ratts,
Singh, Nassar-McMillan, Butler, & McCullough, 2015a), which
were endorsed by

AMCD on June 29, 2015, and by the American Counseling
Association on July
20, 2015. A conceptual framework of the MSJCC visually
depicts the relationships
among the competencies’ key constructs: multicultural and
social justice praxis,
quadrants, domains, and competencies. Implications are
discussed.
Keywords: multicultural, social justice, competencies,
counseling, advocacy
En 2014, la Asociación para la Consejería y el Desarrollo
Multicultural (AMCD,
en sus siglas en inglés) formó un comité para revisar las
Competencias en
Consejería Multicultural desarrolladas por Sue, Arredondo y
McDavis en 1992 y
operacionalizadas por Arredondo et al. en 1996. Este artículo
refleja las compe-
tencias actualizadas, denominadas Competencias en Consejería
Multicultural y de
Justicia Social (MSJCC, en sus siglas en inglés; Ratts, Singh,
Nassar-McMillan,
Butler, & McCullough, 2015a), que fueron avaladas por la
AMCD el 29 de junio
de 2015 y por la Asociación Americana de Consejería el 20 de
julio de 2015. Un
marco conceptual de las MSJCC muestra visualmente las
relaciones entre los
constructos principales de las competencias: la praxis
multicultural y en justicia
social, los cuadrantes, dominios y competencias. Se discuten las
implicaciones.
Palabras clave: multicultural, justicia social, competencias,

consejería, defensoría
The Multicultural Counseling Competencies (MCC)
developed by Sue, Arredondo, and McDavis (1992)
have been instrumental in helping counselors,
psychologists, and othermental health
professionals ad-
dressthe needs of culturally diverse clients, groups,
and communities. Since
their emergence and recognition, multicultural
perspectives have become
embedded into many aspects of the counseling
profession (Erickson Cornish,
Schreier, Nadkarni, Henderson Metzger, & Rodolfa,
2010; Hays & Iwamasa,
2006; Ponterotto, Casas, Suzuki, & Alexander,
2010). The MCC have influ-
Manivong J. Ratts, Department of Leadership and Professional
Studies, Seattle University; Anneliese A. Singh,
Department of Counseling and Human Development Services,
University of Georgia, Athens; Sylvia Nassar-
McMillan, College of Education, North Carolina State
University; S. Kent Butler, Department of Child, Family,
and Community Sciences, University of Central Florida,
Orlando; Julian Rafferty McCullough, Counselor
Education and Supervision program, Georgia State University.
Correspondence concerning this article should
be addressed to Manivong J. Ratts, Department of Leadership
and Professional Studies, College of Education,
Seattle University, 901 12th Avenue, Loyola 216, Seattle, WA
98122 (e-mail: [email protected]).
jOURNAL Of MULTICULTURAL COUNSELING AND

DEVELOpMENT • January 2016 • Vol. 44 29
enced the shaping of the ACA Code of Ethics
(American Counseling Association
[ACA], 2014) as well as otherethical codes
within ACA divisions, such as those
of the Association for Specialists in Group
Work (Singh, Merchant, Skudrzyk,
& Ingene, 2012) and Counselors for Social
Justice (Ibrahim, Dinsmore,Es-
trada, & D’Andrea, 2011). In addition, the
MCC may arguably be viewed as
the catalyst to encourage the development of
additional competencies for
specific populations (e.g., the Association for
Lesbian, Gay, Bisexual, and
Transgender Issues in Counseling [ALGBTIC]
Competencies for Counseling
With Transgender Clients [Burnes et al., 2009];
the ALGBTICCompetencies
for Counseling With Lesbian, Gay, Bisexual, Queer,
Questioning, Intersex,
and Ally Individuals [Harper et al., 2012]). The
integration of the MCC and
thesesubsequent competencies into the counseling
profession has led to
viewing the experiences of historically marginalized
groups more holistically,
and to philosophical and paradigmatic shifts toward
integrating multicultural
constructs in counseling practice.
Since the initial development of the MCC,
therehave been numerous
changes in the multicultural and recently emergent,
but corresponding,
social justice scholarship base,and in the world

at large. For example, re-
search has asserted that the intersections of racial,
ethnic, gender, sexual,
socioeconomic,age, religious, spiritual, and disability
identities have impor-
tant influenceson mental health outcomes and health
disparities (Conron,
Mimiaga, & Landers, 2010; Hankivsky et al.,
2010; Institute of Medicine,
2011). In addition, counselors have realized the
need to take a morecon-
textual approach to working with clients and
communities, recognizing that
individuals are part of a larger ecosystem.
Therefore, understanding these
contexts is becoming increasingly important,
especially for individuals from
historically marginalized backgrounds. Within these
contexts, individuals
not only have multiple identities (e.g., African
American gay man) but also
have intersecting privileged and marginalized statuses
(e.g., male privilege
with racial and sexual minority marginalized
statuses). As society evolves,
multicultural competence among counselors must
also evolve if the coun-
seling profession is to continue to address
the needs of culturally diverse
clients and the social justice concerns that both
shape and contextualize
mental health and overall well-being.
To address the growing need to update the MCC,
Carlos P. Hipolito-Delgado,
as part of his 2014–2015 presidential initiative
for the Association for Multi-

cultural Counseling and Development (AMCD),
commissioned a committee
(Manivong J. Ratts–chair, Anneliese A. Singh,
Sylvia Nassar-McMillan, S. Kent
Butler, and Julian Rafferty McCullough) to revise
the MCC developed by Sue
et al. (1992). The AMCD MCC Revision
Committee’s charge was to update
the MCC (a) to reflect a more inclusive and
broader understanding of culture
and diversity that encompasses the intersection of
identities and (b) to better
address the expandingrole of professional counselors
to include individual
counseling and social justice advocacy. The
revision process involved review-
ing relevant multicultural competency literature in
counseling and other
professions, engaging in discussions with other
professions regarding their
multicultural competency documents, identifying
strengths and gaps within
the original MCC document,and obtaining feedback
from ACA and AMCD
members and leaders through professional electronic
mailing lists and focus
groups conducted at the ACA national conference
(Ratts, Singh, Nassar-
McMillan, Butler, & McCullough 2015b). This
process culminated in the

development of the Multicultural and Social Justice
Counseling Competen-
cies (MSJCC; Ratts, Singh, Nassar-McMillan, Butler,
& McCullough, 2015a),
which were endorsed by the AMCD Executive Council
on June 29, 2015, and
by the ACA Governing Council on July 20, 2015.
The MSJCC, which replace
the original MCC document,can be found on
the ACA and AMCD websites.
The term social justice is incorporated into the title of
the revised com-
petencies to reflect the growing changes in the
profession and society at
large. Moreover,this change reflects the increasing
body of literature on the
interactive nature of multicultural and social
justice competence (Nassar-
McMillan, 2014; Singh & Salazar, 2010).
The MSJCC are also intended to be
aspirational, reflecting the belief that counselors
are all in a constant state
of “being-in-becoming” (Ratts, D’Andrea, &
Arredondo, 2004, p. 29) rela-
tive to developing multicultural and social justice
competence. Therefore,
the development of multicultural and social justice
competence must be
regarded as a lifelong process, in which
counselors aspire to continuously
further their understanding and commitment to
multicultural and social
justice competence and practice cultural humility in
their work (Hook,
Davis, Owen, Worthington, & Utsey, 2013).
The purpose of the MSJCC is threefold. First,

the MSJCC revise and update
the MCC to address current practices and future
needs of the counseling
profession and related fields. Second, the MSJCC
describe guidelinesfor
developing multicultural and social justice
competency for the counseling
profession as it relates to accreditation,
education, training, supervision, con-
sultation, research, theory, and counseling practice.
Finally, the MSJCC merge
the multicultural and social justice counseling
constructs and literature (e.g.,
cultural worldviews, privilege and oppression
experiences) to better address
the complexities of counselor–client interactions.
theoretical and empirical foundations
The theoretical and philosophical perspectives that
undergird the MSJCC
give context to developing multicultural and social
justice competence. The
MSJCC acknowledge the following as important aspects
of counseling prac-
tice for both counselors and clients: (a)
understanding the complexities of
diversity and multiculturalism on the counseling
relationship, (b) recognizing
the negative influence of oppression on mental
health and well-being, (c)
understanding individuals in the context of their
social environment, and (d)

integrating social justice advocacy into the various
modalities of counseling
(e.g., individual, family, partners, group).
Grounding the MSJCC with relevant
multicultural and social justice scholarship is
important to creating a docu-
ment that will be applicableacross populations,
settings, and client issues.
THE INTERSECTION Of IDENTITIES:
UNDERSTANDING THE COMpLExITIES Of IDENTITy
The social construction of identity is a more
dynamic and complex social phe-
nomenon than had been originally conceptualized by the
nascent multicultural
counseling literature. Much has changed in the
world sincethe inception of the
MCC. What was relevant and germane at the
time is not applicablein today’s
multicultural world. For example, earlyin the
evolution of the multicultural
counseling movement, scholars argued that the
term multicultural related to
historically marginalized cultural groups, specifically
African Americans, Asian
Americans, American Indians, and Latina/o Americans
(Jackson, 1995). Other
related marginalized cultural groups, such as
lesbians and gay men, were not
included in this earlydefinition. It was not until
later that the definition of
multicultural was expanded to include othermarginalized
groups, such as les-

bian, gay, bisexual, and transgender individuals (Pope,
1995). Pope’s (1995)
recognition of the complexity of identity has
been important in advancing the
counseling profession’s understanding of the various
identities that contribute
to the human experience.
Relatedly,earlydiscourse on identity development
explained identity as
discrete single variables rather than interconnected
parts of human identity
(Jones & McEwen, 2000; Wijeyesinghe, 2012).
For example, initial racial identity
(Atkinson, 2004; Hardiman, 1982; Helms &
Cook, 1999) and sexual identity
(Cass, 1979) development models conceptualized
race and sex, respectively,
as solitary aspects of social identity without
consideration for otheridentities.
This single-lens perspective on identity is also
reflected in the MCC document
in which race, ethnicity, and culture are emphasized.
A single-lens perspective
on multicultural competence ignores the constellation
of identities that con-
tributes to human identity.
A wide-angle lens approach requires a commitment
to expandingmulticul-
tural competence to include the intersection of
identities. Acknowledging
the existence of multiple intersecting identities is an
important precursor to
understanding the complexities of health experiences
for individuals from
marginalized groups (Bowleg, 2012). The origins of
the term intersectional-

ity have been attributed to the work of Kimberlé
Crenshaw in the field of
gender studies (McCall, 2005). The dominant
discourse on intersectionality
is that race, ethnicity, gender, sexual orientation,
economic status, religion,
spirituality, and disability status are social
constructions that collectively en-
compass human identity (Robinson, 1999).
Socially constructed aspects of
identity intersect fluidly at various points in a
person’s life and contribute
to one’s position and status in society
(Harley, Jolivette, McCormick, & Tice,
2002). Social identity group membership also
shapes how people understand
the world and the ways that privilege and oppression
are experienced (Cro-
teau, Talbot, Lance, & Evans, 2002). This
perspective is reflected in Jones
and McEwen’s (2000) research on identity
development, which touched on
the complexity of identity development processes.In
their research, Jones
and McEwen concluded that the collection of identities
that make up each
individual could not be understood in isolation.
Furthermore, a person’s
environment influenceswhich aspects of identity
are salient for an individual

at a given moment in time.
OppRESSION AND MENTAL HEALTH:
THE INFLUENCE OF OPPRESSION ON WELL-BEING
It is difficult to talk about social group
identity without inevitably discuss-
ing issues of oppression. Oppression exists in
the form of racism, sexism,
heterosexism, classism, ageism, ableism, and religious
oppression, among
others (Adams, Bell, & Griffin, 2007), and it
manifests on an individual and
systems-wide scale(Adams et al., 2007; Hardiman &
Jackson, 1982). At the
individual level, oppression can be based on
dehumanizing interpersonal
interactions with others that occur over time
(MacLeod, 2013; Turner &
Pope, 2009). Pierce (1970) referred to these
experiences as microaggressions,
which are brief dailyassaults experienced by
marginalized individuals that
can take the form of verbal or nonverbal forms of
behavior. At the systems
level, oppression manifests itselfin the form of
rules, policies, laws, and in-
stitutions that create inequities for marginalized
individuals (Adams et al.,
2007; Young, 2004). Whether intentional or
unintentional, oppression has
a devastating influence on the mental health of
historically marginalized in-
dividuals and communities (Banks, Kohn-Wood, &
Spencer, 2006; Williams
& Mohammed, 2009).

Oppression is harmful to the well-being of
both privileged and oppressed
individuals. With respect to privileged groups,
Corrigan and Miller (2004)
contended that those who associate with stigmatized
individuals also experi-
ence stigma themselves. Goffman (1963) coined
this phenomenon as courtesy
stigma. Courtesy stigma can lead those who
associate with stigmatized individuals
to develop low self-esteem (Markowitz, 1998;
Tsang, Tam,Chan, Cheung, &
Chang, 2003), to withdraw from social interactions
to avoid rejection (Phil-
lips, Pearson, Li, Xu, & Yang, 2002; Stengler-
Wenzke, Trosbach, Dietrich, &
Angermeyer, 2004), and to develop psychological
distress (Martens & Add-
ington, 2001; Mickelson, 2001).
Scholars have used the term minority stress (Meyer, 1995,
2003) to refer to
the process of how societal oppression and stigma
that members of histori-
cally marginalized groups experience lead to
negative health outcomes (Díaz,
Ayala, & Bein, 2004). For example, because of
homophobia and heterosexism,
sexual minority adolescents have been identified as
having a greater risk for
suicidal behaviors compared with their heterosexual peers
(Kann et al., 2011).

Similarly, as a result of racial and sexual
discrimination, transgender people
of colorhave been found to be at a high risk
for suicide, as well as substance
abuse, HIV/AIDS, and hate crimes (Xavier, Bobbin,
Singer, & Budd, 2005). In
addition, researchers have suggested that the stressors
associatedwith living
in poverty impair cognitive functioning (Mani,
Mullainathan, Shafir, & Zhao,
2013). Furthermore, sexism has been attributed to
creating gender disparities
in depression, anxiety, somatization, and low self-
esteem between men and
women (Klonoff, Landrine, & Campbell,2000). In
addition, the combina-
tion of racism and the belief that unfair
treatment was inevitable correlated
with higher levels of blood pressure among
young African American men
(Krieger & Sidney, 1996). These findings aptly
support the biopsychosocial
influence of oppression.
THE SOCIOECOLOGICAL pERSpECTIVE:
UNDERSTANDING INDIVIDUALS IN THE CONTExT Of
THEIR ENVIRONMENT
An understanding of intersectionalities and the
influence of oppression on
mental health and well-being requires a
commitment to exploring individuals
and their social environment. When a contextual
lens is applied to human
development issues, counselors begin to realize

that a multilevel approach is
necessary (Lewis, Arnold, House, & Toporek, 2003;
Ratts, Toporek, & Lewis,
2010). A multilevel approach that uses a combination
of individual counseling
and social justice advocacy is needed to address
the prevalence of oppression
on mental health (Lewis, Lewis, Daniels, &
D’Andrea, 2011). Individualcoun-
seling involves working directly with clients within
the structure of an office
setting. In contrast, social justice advocacy entails
working in the community
setting to address a systemic barrier.
Bronfenbrenner’s (1979) seminal work provided a
multilevel framework for
understanding how individuals shape—and are
reciprocally shaped by—their
environment. His work led to the development of
socioecological models to
understand the interactive relationship between
individuals and their envi-
ronment (Golden & Earp, 2012). The
socioecological model has become
popular in health promotions because it focuses
on the individual and the
social environment as targets for health
interventions (Stokols, 1992). A so-
cioecological approach provides counselors a
framework for understanding
the extent to which individuals and their social
environment influence each
other(Cook, 2012; McMahon, Mason, Daluga-
Guenther, & Ruiz, 2014). More-
over,counselors and related helping professionals
can explore the degree to

which oppressive environmental factors influence
the health and well-being
of individuals. For example, a socioecological
perspective can be helpful in
determining whether problems are entrenched in
the individual or in the
environment (Conyne & Cook, 2004).
McLeroy, Bibeau, Steckler, and Glanz’s (1988)
socioecological model
discusses five levels of influence contributing to
health behavior that have
become popularized in health promotions: (a)
intrapersonal (i.e., individual
characteristics of a person, such as attitudes,
knowledge, behaviors, and skills),
(b) interpersonal (i.e., an individual’s social
network and support systems,
such as family, friends, and work peers), (c)
institutional (i.e., social institu-
tions, such as schools, church, businesses, and
community organizations),
(d) community (i.e., the norms and values of a
community), and (e) public
policy (i.e., local, state, and federal policies
and laws). The authors added
to this sphere of influence by incorporating the
international/global level.
International/global politics and affairs are having an
increased influence
on human growth and development as well as on

psychological well-being.
As a society, we are becoming more globalized as
evidenced by more globally
interdependent economies, which involve not only
the outsourcing of various
products and services, but also the use of migrant
workers in the domestic
laborforces, both legal and illegal immigration, and
trauma and refugee
crises, to name a few.
By using the socioecological model as a
framework, counselors can deter-
mine in partnership with clients whether
interventions should occur at the
intrapersonal, interpersonal, institutional, community,
public policy, and/
or international/global levels. Intrapersonal
interventions involve working
directly with the individual. Interpersonal
interventions require working
with an individual’s social network, such as family,
friends, and colleagues.
Institutional interventions entail addressing
systemic issues influencing indi-
vidual health. Community interventions involve
attending to the spoken and
unspoken norms and values embedded in society
that influence individuals.
Public policy interventions require addressing
local, state, and federal poli-
cies and laws that affect the well-being of
individuals. Finally, international/
global interventions involve addressing world
affairs that obstruct the health
and well-being of clients.

BALANCING INDIVIDUAL COUNSELING AND
SOCIAL jUSTICE ADVOCACy
Effectively balancing individual counseling with social
justice advocacy is key
to addressing the problems that individuals from
marginalized populations
bring to counseling. Certain situations will call
for individual counseling.
Other situations may require interventions that take
place in the community.
The challenge,therefore, is knowing when to work in
the office setting and
when to work in the community realm. Being
able to balance individual
counseling with social justice advocacy is
important to avoiding burnout and
to developing clear boundaries.
Determining whether to provide individual counseling
or social justice
advocacy begins with the client (Lewis et al.,
2011). Starting with the client
allows counselors to be attuned to the
multicultural and social justice is-
sues that clients bring to therapy. This approach
provides counselors with
insight into whether intervening on an individual or
community-wide scale
is appropriate.
the mSJCC framework

The tenets upon which the MSJCC are built are
depicted in a conceptual
framework that has, at its core, multiculturalism
and social justice (see
Figure 1). Specifically, quadrants are used to
illustrate intersections of identi-
ties and the various ways that power, privilege, and
oppression come to life
in the counseling relationship. Developmental
domains, which are repre-
sented by the concentric circles overlapping
each quadrant, represent the
belief that multicultural and social justice
competence begins with counselor
self-awareness.This self-awareness then extends to clients,
to the counseling
relationship, and to counseling and advocacy
interventions and strategies.
FIGURe 1
Multicultural and Social Justice Counseling Competencies
Note. From Multicultural and Social Justice Counseling
Competencies (p. 4), by M. J. Ratts,
A. A. Singh, S. Nassar-McMillan, S. K. Butler, and J. R.
McCullough, 2015. Retrieved from
https://www.counseling.org/docs/default-
source/competencies/multicultural-and-social-justice-
counseling-competencies.pdf. Copyright 2015 by M. J. Ratts, A.
A. Singh, S. Nassar-McMillan,
S. K. Butler, and J. R. McCullough. Reprinted with permission.
PRIVILEGED COUNSELOR
MARGINALIZED COUNSELOR

MARGINALIZED
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MULTICULTURAL AND
SOCIAL JUSTICE PRAXIS

Within the first threedomains are developmental
competencies: attitudes
and beliefs, knowledge, skills, and action
(AKSA).
MULTICULTURAL AND SOCIAL jUSTICE pRAxIS
At the heartof the MSJCC is multicultural and
social justice praxis. The MSJCC
reflect a charge to counselors and otherhelping
professionals to integrate
multiculturalism and social justice into their
counseling practice. Ethically,
counselors must consider both multiculturalism and
social justice in their work
with clients (ACA, 2014; Durham & Glosoff,
2010). This connection arises in
part because of the intersection between multicultural
competence and social
justice in counseling (Nassar-McMillan, 2014;
Singh & Salazar, 2010). Multi-
culturalism helps counselors gain insight into
the inequities experienced by
clients from marginalized groups as well as the
privileges bestowed to clients
from privileged groups (Arredondo & Perez, 2003;
Crethar, Torres Rivera, &
Nash, 2008; Ponterotto et al., 2010).
Multicultural insights into theseinequi-
ties can help counselors identify and engage in
social justice initiatives that

require individual- and systems-level work (Lewis &
Arnold, 1998).
QUADRANTS: pRIVILEGED AND MARGINALIzED
STATUSES
Quadrants are used to illustrate the intersection of
identities and the ways
that power, privilege, and oppression play out
between counselors and clients
with regard to their privileged and marginalized
statuses. The assumption is
that power, privilege, and oppression influence the
counseling relationship
to varying degrees contingent on counselors’
and clients’ privileged and mar-
ginalized statuses (Ratts & Pedersen, 2014).
Privilegedgroup members are
those who hold power and privilege in society
(Adams et al., 2013; McIntosh,
1986; Roysircar, 2008). In contrast, marginalized
group members are those
who are oppressed in society and lack the systemic
advantages bestowed on
privileged groups. These privileged and marginalized
statuses are categorized
into four quadrants reflecting the different types of
interactions that occur
between counselor and client:
Privileged counselor–marginalized client quadrant. This
quadrant reflects the relationship
that exists when clients from marginalized groups
are recipients of counseling from
counselors who are members of privileged groups. In
such a relationship, counselors

hold social power and privilege over clients by
virtue of their privileged status. A White
counselor working with a client of color; a
male counselor working with a female cli-
ent; and a heterosexual counselor providing counseling
to a lesbian, gay, or bisexual
client are a few examples.
Privileged counselor–privileged client quadrant. This
quadrant characterizes the interaction
between counselors and clients who share a
privileged status. In such a relationship,
counselors and clients share social power
and privilege in society. Examples include
a White counselor working with a White client
and a male counselor working with a
male client.
Marginalized counselor–privileged client quadrant. The
relationship between privileged
clients and counselors from marginalized groups is
reflected in this quadrant. Within
this relationship, clients hold social power and
privilege. This relationship may involve a
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Journal of LGBT Issues in Counseling, 9:92–117, 2015
Copyright © Taylor & Francis Group, LLC
ISSN: 1553-8605 print / 1553-8338 online
DOI: 10.1080/15538605.2015.1029204
Religion, Spirituality, and LGBTQ Identity
Integration
BRENDA L. BEAGAN
School of Occupational Therapy, Dalhousie University, Halifax,
Nova Scotia, Canada
BRENDA HATTIE

Women’s Studies, Mount Saint Vincent University, Halifax,
Nova Scotia, Canada
Processes of navigating intersections between spiritual/religious
identity and lesbian, gay, bisexual, transgender, or queer
(LGBTQ)
identity are just beginning to be explicated. In-depth interviews
with
35 LGBTQ adults from a range of backgrounds explore
experiences
with religion and spirituality. Although not all participants
expe-
rienced conflicts, the psychological and emotional harms done
to
some participants through organized religion were extensive and
knew no age boundaries. Disconnection from bodies and
delayed
sexual activity were common. Many left formal religions; those
who
stayed distinguished between religious teachings and
institutions,
and between religion and spirituality. Heightened knowledge of
theology proved helpful to some. Limitations and implications
for
counseling are discussed.
KEYWORDS religion, spirituality, LGBT, queer, identity,
conflict,
integration, counseling
Lesbians, gay men, bisexuals, transgender people and those who
identify
as queer (LGBTQ) almost inevitably have conflicted
relationships to religion
and spirituality. Condemnation by mainstream faith traditions
has inflicted

considerable harm on sexual and gender minorities. The purpose
of this
study was to explore how a range of LGBTQ individuals
experienced and
perceived religion and spirituality. In particular, it was to
examine potential
identity conflicts, how people sought to resolve conflicts for a
coherent sense
of self, and how they experienced the place of spirituality and
religion in
Address correspondence to Brenda L. Beagan, School of
Occupational Ther-
apy, Dalhousie University, P. O. Box 15000, Halifax, NS B3H
4R2, Canada. E-mail:
[email protected]
92
Religion, Spirituality, and LGBTQ Identity 93
LGBTQ communities. The results may alert counselors to
critical factors at
both individual and community levels.
LITERATURE REVIEW
The Place of LGBTQ in Mainstream Religions
Religion and spirituality are fraught with tension for many
LGBTQ peo-
ple, as most mainstream religions denounce variance in sexual
orientation
and gender identity to some degree (Yip, 2005). Although not
all LGBTQ

people involved with organized religions experience identity
conflict (Murr,
2013; Rodriguez, 2009; Subhi & Geelan, 2012), many do. As
Barton (2010)
suggested, “The stakes are high when even one’s thoughts
threaten one’s
eternal soul. Fear of hell is a powerful motivator . . . it terrifies
young people
who cannot control for whom they feel a romantic and sexual
attraction” (p.
471).
A growing body of research has documented the often-intense
iden-
tity conflicts experienced by LGBQ Christians (Barton, 2010;
Dahl & Galli-
her, 2009, 2012; Garcı́a, Gray-Stanley, & Ramirez-Valles, 2008;
Murr, 2013;
Ream & Savin-Williams, 2005; Rodriguez, 2009; Rodriguez &
Ouellette, 2000;
Schuck & Liddle, 2001; Super & Jacobson, 2011). Far less
research has been
conducted with transgender Christians. Compared with sexual
orientation,
explicitly intolerant religious teachings concerning gender
identity are fewer,
though more conservative Christian faiths proscribe rigid
gender roles, leav-
ing congregants unclear where gender variance fits (Kidd &
Witten, 2008;
Levy & Lo, 2013; Westerfield, 2012). Perhaps because of this
ambiguity, there
are indications that transgender people may be more involved
with religiosity
than are gays and lesbians (Frederiksen-Goldsen, 2011).
Nonetheless, many

experience intolerance and hostility, and some have been asked
not to dis-
close their transgender identity and/or to leave their churches
(Levy & Lo,
2013; Westerfield, 2012; Yarhouse & Carrs, 2012). Like other
LGBQ people,
they are less likely to be involved with organized religion than
the general
population (Porter, Ronneberg, & Witten, 2013).
Research is also scarce concerning LGBTQ people in faith
traditions
other than Christianity, though there is some suggestion that
Judaism, Native
spirituality, Buddhism, and Hinduism are more welcoming
(Porter, Ron-
neberg, & Witten, 2013; Schnoor, 2006; Westerfield, 2012).
There is some
debate about the extent to which Islam condemns male
homosexuality,
though culturally and legally it is highly intolerant (Jaspal,
2012; Siraj, 2011).
It is virtually silent on lesbianism, which is culturally seen as
incompati-
ble with Islam (Siraj, 2011). The scant research evidence
available indicates
Muslim LGBTQ people experience tremendous identity conflict
stemming
from religious and cultural condemnation (Jaspal, 2012; Siraj,
2012). Jaspal
(2012) suggests that though Sikh and Hindu religions do not
explicitly forbid
94 B. L. Beagan and B. Hattie

homosexuality, cultural norms mean LGBTQ people fear loss of
family and
community.
Acceptance of homosexuality within Judaism varies from
Orthodox in-
tolerance to widespread acceptance in Reform and
Reconstructionist tradi-
tions (Abes, 2011). In one study with lesbian and bisexual
women, all of the
participants’ synagogues had been at least somewhat open to
LGBTQ mem-
bers, with several supportive rabbis (Barrow & Kuvalanka,
2011). Nonethe-
less, Schnoor’s (2006) found that Jewish gay men in Toronto,
Canada, all
engaged in struggles to integrate gay and Jewish identities.
Psychological and Emotional Consequences for LGBTQ People
There is now compelling evidence that conflict between sexual
or gender
identity and religious teachings can significantly damage the
psychological
and emotional well-being of LGBTQ individuals (e.g., Barton,
2010; Bowers,
Minichiello, & Plummer, 2010; Ganzevoort, van der Laan, &
Olsman, 2011;
Garcı́a et al., 2008; Hattie & Beagan, 2013; Lease, Horne, &
Noffsinger-
Frazier, 2005; Ream & Savin-Williams, 2005; Rodriguez, 2009;
Rodriguez &
Ouellette, 2000; Schnoor, 2006; Schuck & Liddle, 2001). Super
and Jacobson
(2011) argued that the psychological distress extends as far as

“religious
abuse,” using the power of position and teachings to oppress,
coerce, and
manipulate LGBTQ people through shaming, stigmatizing,
rejecting, ousting,
exorcising, and ex-communicating (Super & Jacobson, 2011).
Barton (2010)
reported that simply living in a “Bible belt” region of the
United States was
described by gays and lesbians as a “spirit-crushing experience
of isolation,
abuse, and self-loathing” (p. 477).
Depending on degree of welcome or intolerance, LGBTQ people
may
be harmed emotionally, mentally, and spiritually, either within a
religion or
in choosing (or being forced) to leave a religion (Ream &
Savin-Williams,
2005). People often struggle with confusion, low self-esteem,
guilt, shame,
isolation, hopelessness, depression, anxiety, fear of damnation,
feelings of
worthlessness and inadequacy, and suicidal ideation (Barton,
2010; Dahl
& Galliher, 2009, 2012; Garcı́a et al., 2008; Jaspal, 2012;
Rodriguez, 2009;
Schuck & Liddle, 2001; Siraj, 2012; Subhi & Geelan, 2012;
Super & Ja-
cobson, 2011). This litany of harms appears to include
transgender peo-
ple, at least in Christian traditions (Westerfield, 201; Yarhouse
& Carrs,
2012).
Evidence concerning psychological well-being is mixed. Clearly

gays
and lesbians affiliated with nonaffirming Christian traditions
develop greater
internalized homophobia and lower self-esteem (Barnes &
Meyer, 2012;
Bowers et al., 2010), yet it is not clear that those are
accompanied by poorer
psychological well-being or greater depression (Barnes &
Meyer, 2012).
Affiliation with affirming religions seems to benefit
psychological health,
self-esteem and spirituality, for LGBQ and transgender people
(Lease et al.,
2005; Rodriguez, Lytle, & Vaughan, 2013; Yarhouse & Carrs,
2012). The
process of reconciling or integrating religious and sexual/gender
identities
appears to strengthen spirituality, self-acceptance, and
acceptance of others
(Dahl & Galliher, 2012; Murr, 2013; Yarhouse & Carrs, 2012).
Staying, Leaving, and Integrating
Several studies have found similar patterns in LGBTQ response
to conflicts
with religious identities: rejecting the gay identity, rejecting the
religious
identity, compartmentalizing the gay self and religious self, or
identity inte-
gration. These patterns have been found with gay and lesbian
Christians in

the United States and The Netherlands (Ganzevoort et al., 2011;
Rodriguez
& Ouellette, 2000), with Latino gay men (Garcı́a et al., 2008),
and with Jew-
ish gay men (Schnoor, 2006). Such patterns are less clear for
transgender
people, but there is evidence that they disproportionately
change faith tradi-
tions, leave organized religions altogether, or try out new faith
traditions and
spiritual paths (Kidd & Witten, 2008; Levy & Lo, 2013; Porter,
Ronneberg &
Witten, 2013).
For some, the process of identity integration means changing
religions,
reducing participation, or changing denominations or
congregations, but
it can also mean altering beliefs or relationship to beliefs
(Brennan-Ing,
Seidel, Larson, & Karpiak, 2013; Dahl & Galliher, 2012; Garcı́a
et al., 2008;
Schuck & Liddle, 2001). Some distinguish between spirituality
and religion,
seeing the latter as political and fallible; some deepen their
knowledge,
identifying where doctrines may deviate from original spiritual
teachings;
some focus more on the core spiritual values of their faith
tradition, such
as love, compassion, and respect (Barrow & Kuvalanka, 2011;
Barton, 2010;
Brennan-Ing et al., 2013; Dahl & Galliher, 2009; Levy & Lo,
2013; Murr, 2013;
Schnoor, 2006; Schuck & Liddle, 2001; Siraj, 2012;
Westerfield, 2012).

For counselors working with LGBTQ clients, obviously
acknowledging
that religion may have left lasting scars is critical, though it is
important not
to assume conflict (Rodriguez, 2009). Kocet, Sanabria, and
Smith (2011) sug-
gested a framework for counselors: understand the relevance of
religion and
spirituality to the client, explore unresolved feelings, help
clients identify
what relationship they want to spirituality and religion, and help
clients con-
nect with resources in LGBTQ and faith communities. Bozard
and Sanders
(2011) put forward the goals, renewal, action, connection,
empowerment
model (GRACE) for use with LGB clients who want to explore
religious
forms of spiritual engagement. Counselors may help clients
identify their
goals, find renewed hope in spiritual engagement, determine
action such
as altering relationship to an existing faith tradition or trying a
new one,
facilitate a different connection with the divine and/or with
community, and
promote empowerment as clients navigate identities.
THIS STUDY
This qualitative study was conducted on the East coast of

Canada. We explore
relationships to spirituality and religion among LGBTQ people
of varying
gender identities and sexual orientations. The study is novel in
including
the spectrum of LGBTQ identities, as well as including
participants from
any religious or spiritual background and any current beliefs
and practices,
including none. We examine not only past and current
experiences, beliefs
and desires, but also perceptions of the place of religion and
spirituality in
LGBTQ communities.
METHOD
Approved by the Research Ethics Board at the lead researcher’s
university,
this study used interpretive description, a qualitative
methodology designed
to explore direct experiences analyzed through an interpretive
lens informed
by theory (Thorne, 2008). Grounded in critical theory,
semistructured inter-
views were used to explore participant experiences of religion
and spiri-
tuality, and the meanings those hold. Participants were recruited
through
notices distributed via LGBTQ websites and Facebook pages, in
bars and
community sites, as well as e-mail networks. Maximum
diversity was sought,
in sexual orientation, gender identity, age, ethnicity,
relationship to orga-
nized religion when growing up, and current affiliations.

Recruitment was
targeted as needed to fill gaps in diversity, such as when few
Buddhists were
volunteering. The response was overwhelming, and recruitment
had to be
halted at 35 people due to resources. Saturation had been
reached on major
themes.
Following discussion of informed consent, each person
participated in
an audio-recorded interview that lasted 1 to 3 hours. Interviews
asked about
LGBTQ identity and processes of disclosure, religion and
spirituality while
growing up, changes over time in LGBTQ identity and in
religious/spiritual
beliefs and practices, and integration of LGBTQ self and
spiritual self, per-
sonally and in the broader LGBTQ community. Interviews were
transcribed
verbatim, and pseudonyms were assigned. AtlasTi (Version 6.5)
qualitative
data analysis software was used to code data through regular
team discus-
sions interpreting transcripts. Analysis drew on coded data, but
also returned
to raw transcripts repeatedly, reading and re-reading, comparing
across indi-
viduals, and exploring potential patterns by demographic
differences (Boy-
atzis, 1998). A summary report was sent to all participants for
feedback, and
results were presented at two workshops attended by LGBTQ
community
members. Responses indicated that preliminary analyses

resonated.
The team comprised two researchers, both raised Christian. One
of us
left her faith tradition as a young adult, one joined a Pentecostal
church
TABLE 1 Participant Demographics
Age (Years) # Gender Identity # Sexual Orientation #
20–30 11 Man 11 Gay 10
31–40 6 Woman 19 Lesbian 11
41–50 7 Trans/queer 4 Bisexual 4
51–60 7 Other 1 Heterosexual 1
61+ 4 Queer 7
Other 2
Ethnicity (#)
Euro-Canadian 23
Jewish 4
Other 8
in her twenties (she was asked to leave the church in her
thirties.) One of
us identifies as highly spiritual, the other less so. One identifies
as lesbian,
the other as queer. We have academic training in sociology,
education, and
women’s studies. We are both of White Canadian heritage. Our
differing
experiences and perspectives provided checks and balances

during data
interpretation, enriching our analyses.
Participants
Participants ranged in age from 20 to 68, fairly evenly
distributed (see
Table 1). About two thirds were Euro-Canadian, which is
somewhat less
than the population of the region. Participants included 19
women, 11 men,
four transgender or gender queer, and one other gender. Most
identified as
gay or lesbian, four as bisexual, seven as queer, one as
heterosexual, one as
Two Spirit (an Aboriginal sexuality/gender identity), and one as
other. Five
were raised in Jewish traditions, one was raised with no faith
tradition, the
rest grew up in Christian traditions with varying degrees of
intensity. This is
about the same proportion of Christians that constitutes the
local population
(Statistics Canada, 2005). Four had studied theology or divinity
in different
Christian traditions. The participants included clergy as well as
deacons and
church elders.
We have categorized the Christian participants as having been
raised
“intensely” or “somewhat” Christian (see Table 2). This is a
distinction we
have imposed, not their words. The 12 “somewhat” Christian
participants
grew up with organized religion, may or may not have attended

church
regularly, were not very involved beyond that, and typically did
not discuss
religion at home. They were raised in Catholic, Anglican,
Salvation Army,
and a few mixed faith traditions. The 18 “intensely” Christian
participants
grew up in Presbyterian, Baptist, Catholic, and Pentecostal/
fundamentalist
evangelical faith traditions. Two were raised in the United
Church. All were
heavily involved in church, usually in youth groups, choir,
Bible study. They
TABLE 2 Faith Tradition Growing Up and Current Beliefs
Tradition Raised In # Current Beliefs #
Non-Christian 6a None 8
Somewhat Christian 12a Spiritual 8
Intensely Christian 18 Christian 7
Other 4
Jewish 3
Buddhist 3
Pagan 2
aAdds to more than 35; one person was raised by one Jewish
parent, one Christian parent.
led church camps, were altar boys, became church elders or
deacons, studied

theology, worked for their churches. Religion was often central
to family,
schooling, and community.
RESULTS
The theme that dominated interviews concerns the ways faith
traditions
negatively affected LGBTQ people, including shame, guilt, sex
negativity,
disconnection from body, and severing of relationships to self
and others. A
second major theme concerns how people resolved any conflicts
between
their LGBTQ identities and their religious or spiritual beliefs. A
final theme
concerns the relationships between spirituality and LGBTQ
communities.
There were no age patterns in our interviews. Stories of harms
done
through faith traditions were as intense for those in their
twenties as those
in their fifties and sixties. A few of the younger participants
were raised
in relatively tolerant religions and actually sought out more
conservative
groups, usually seeking a place of belonging or emotional
intensity.
Conflicts between LGBTQ Identities and Religion/Spirituality
The five participants who were raised Jewish (Conservative and
Reform)
did not appear to have internal conflicts in coming to terms with
LGBTQ

identities. Some were raised in secular families and experienced
Judaism
as connection with a people more than religion (Abes, 2011).
For some,
however, Judaism provided direction for living a moral and
ethical life, at
individual and community levels.
Judaism was very much my moral compass; like, it was very
much rooted
in how to be a better person.... It’s such a huge part of who I
am, and
how I see the world and how I navigate the world, and my
relationship
to everything from food to money to sex and gender. (Deborah,
queer
woman, 26)
None of the Jewish participants experienced religious or
spiritual shame in
relation to being LGBTQ. Some had heard no teachings about
homosexual-
ity while growing up; one suggested that while Jewish teachings
assumed
heterosexuality, they were not overtly homophobic. One woman
had only
encountered rabbis who were strongly supportive of LGBTQ
rights.
In general, the non-Christian participants did not experience
internal
conflict, guilt, or shame. This may be because they were not

exposed to
teachings about sin and evil, but it may also be because three of
them
(two Jewish, one atheist) identified as transgender. Two other
participants
who identified as transgender or gender fluid, who were raised
Christian,
also experienced little or no conflict between religious beliefs
and gender
identity. It is possible that the religious messages they heard
concerning
gender identity were not explicitly intolerant.
For 18 of the 29 participants who were raised Christian, internal
conflicts
had been intense (16 were raised intensely Christian). Several
described
deep shame as they struggled to come to terms with their sexual
orientation.
For example, Natasha (raised Catholic) said, “I didn’t have
barriers of guilt
regarding what God specifically would think. But I did have the
internalized
shame associated with sexuality that just gets conditioned into
you, if you’re
part of the church from a very young age” (bisexual woman,
20). Also raised
Catholic, Sam (gay man, 48) learned to see same-sex desire as
“something
dirty, to be ashamed of, to be hidden.” With prevalent messages
about gay
people being “child molesters,” he feared becoming “a
monster.”
Participants from evangelical churches and some Catholics
struggled

with the belief that their sexual orientation meant they were
sinners and
would go to hell. Deirdre had left church in her early twenties,
while coming
out as lesbian. At age 27, she said, “Part of me is a little scared,
I guess. You
get taught if you don’t follow this path of righteousness, you’re
going to
hell.” Melanie had left her evangelical church as a teen:
But I still believed a lot of that stuff. Or feared that that was the
way
it was; that there was some horrible deity that was watching,
and just
waiting for an opportunity to land on you like a ton of bricks.
(bisexual
woman, 56)
Beyond homonegative messages, several participants had
experienced
church as more broadly sex negative. Of his Wesleyan family,
Daniel said,
“We could watch a little bit of television, and if there was any
reference made
to sexuality, (gasps), you know, ‘Isn’t that awful? Isn’t that
disgraceful? Isn’t
that disgusting?" (gay man, 48). Raised Catholic, Jardine said,
“Conversations
about sexuality and sex and homosexuality were always very
negative. And
more than homophobia, . . . more problematic for me was the
intensely
sex-negative attitude” (queer woman, 26). Several participants
said the

construction of even masturbation as sinful left them feeling sex
in general
was shameful, and same-sex attraction doubly so.
DELAYED SEXUAL ACTIVITY
Not surprisingly, given negative messages, many participants
delayed sexual
activity until relatively late in life. They simply avoided sex.
Natasha said
though all her teen peers were sexually active, she was
paralyzed by “inter-
nalized shame that was associated with having sex.” When she
did have sex
with a male partner she experienced tremendous self-loathing :
It just all compounded to the point where I felt disgusted with
myself, for
being sexual. I felt disgusted by the idea of being sexual with
somebody,
even if I knew that that person loved me, I still felt really weird
and just
wrong, thinking about having sex with someone. (bisexual
woman, 20)
Similarly, Kyle (raised Presbyterian) avoided sex until he was
well into his
twenties, yet in his first sexual relationship a lot of early
messages arose,
“It started bringing up things like, no sex before marriage and
things like
that. They were still really ingrained in me” (gay man, 29).
Other partici-

pants, too, found initial sexual intimacy challenging, as they
battled guilt and
shame.
Sam said in his Catholic upbringing “sex was essentially viewed
as a
necessary evil.” As a result he was distanced from his physical
self, with
“hangups about sexuality, in general” as well as about his body
(gay man,
48). Similarly, Beth described herself as having been “a
disembodied head”
for decades; it was only in her forties, more than 20 years after
coming out,
that she began to integrate her body into her sexuality (lesbian
woman, 47).
Raised in a culture where girls holding hands was very common,
Amani
always avoided touching friends, fearing her body might betray
her, “What
if you think I like you in a way that I shouldn’t?” (bisexual
woman, 28).
Separation from the body and delaying sexual activity allowed
partici-
pants to come to terms with identity apart from feelings and
beliefs about
sex. As Kyle said, throughout his teens and into his twenties,
sexuality was
“on the back burner”: “I wasn’t seeking a relationship with
anyone. I wasn’t
engaging in sexual behaviour and things like that. I was very
much kind of
a, a neutral body, I guess” (gay man, 29). Dierdre used almost
the same lan-
guage, describing herself as putting sexuality on the “back

burner . . . didn’t
even think about it . . . never dated until I was twenty two”
(lesbian woman,
27). She experienced herself as devoid of sexual desire.
DENIAL OF THE SELF
In addition to the ways some participants put their sexual selves
and ex-
ploration of their bodies on hold, some denied or separated from
whole
aspects of themselves. Raised Catholic, Lee-Anne disavowed
her bisexuality
for many years, “I could somewhat hide behind the fact that I
was still at-
tracted to men.... I never really mentioned that other part of
myself, which
was difficult because it was just– I really denied a part of who I
was” (bisex-
ual woman, 33). Twenty years later, she has never disclosed to
her family
or friends in her hometown. Still active in her faith, she
experiences her
sexuality and her religion as totally separate.
Raised in a “very Catholic” family, early on Ross decided he
could not
be “worthwhile and successful” if he were gay, so he denied his
feelings
for men for about 30 years. Beth came out as lesbian in her
twenties but

felt highly separated internally for years, “It took me a long
time to fully be
myself. I think I tried to pass as not a lesbian in a lot of
situations, for most
of my life, until the last couple years” (lesbian woman, 47). She
was quite
judgmental of others who looked “too” gay. Sexually active as
an adolescent,
Will still kept his Christian and gay selves separate:
I used to have to segregate it in my body, in my mind. It’d be
like, “Okay,
with my gay friends, I do gay things. And we talk about gay
things. And
with my Christian friends, we talk about Christian things and
Biblical
things and conservative things.” . . . Segregation makes a
person crazy.
(gay man, 30)
Not only did participants deny or separate from parts of
themselves, but
some turned to their faith to banish unwanted desires. A deacon
and elder
in an evangelical church, Peter saw his same-sex attractions and
occasional
encounters as shameful, and prayed for redemption, “There
wouldn’t be a
day that I wouldn’t pray to God that that desire would be taken
away. . . . It
drove me nuts” (gay man, 59). In his twenties his minister
directed him to a
Christian program aimed at healing sexual and relational
“brokenness”:
He put me on this Living Waters program, and all I would do is

listen to
the tapes and hear a voice that was so distinctively gay
confessing that
he was healed and he was all better (laugh)....Well, I fantasized
what he
looked like! (laugh) Honestly, the more intense the procedures
to deny
it, the more real it became.
Two other participants also engaged in church-based programs
to try to
exorcise their demons. Others willingly or unwillingly had
congregations
pray over them to heal their sexuality. One who refused was
forced to leave
his church; he did leave, but he also went back in the closet.
Another young
man was forced to attend a residential program thousands of
miles away for
“conversion therapy.” Later, church leaders told him there was
no place for
him in the church.
LOSSES: COMMUNITY, FRIENDS, FAMILY
Those who were asked to leave a church because they were
LGBTQ gen-
erally experienced profound loss. Often the church was their
entire social
network: family, friends, community. Many who were highly
active in their
churches—clergy, secretary, outreach worker, youth group

leader, choir,
deacon, elder—lost those organizational roles when they came
out (or were
outed). Even those who gradually left religions lost friends,
community, and
family. All but two …
LGBTQ Relationally Based Positive Psychology:
An Inclusive and Systemic Framework
Daniela G. Domínguez, Monte Bobele, Jacqueline Coppock, and
Ezequiel Peña
Our Lady of the Lake University
Positive psychologists have contributed to our understandings
of how positive emotions and flexible
cognition enhance resiliency. However, positive psychologists’
research has been slow to address the
relational resources and interactions that help nonheterosexual
families overcome adversity. Addressing
overlooked lesbian, gay, bisexual, transgender, or queer
(LGBTQ) and systemic factors in positive
psychology, this article draws on family resilience literature and
LGBTQ literature to theorize a systemic
positive psychology framework for working with
nonheterosexual families. We developed the LGBTQ
relationally based positive psychology framework that
integrates positive psychology’s strengths-based
perspective with the systemic orientation of Walsh’s (1996)
family resilience framework along with the
cultural considerations proposed by LGBTQ family literature.
We theorize that the LGBTQ relationally
based positive psychology framework takes into consideration
the sociopolitical adversities impacting

nonheterosexual families and sensitizes positive psychologists,
including those working in organized care
settings, to the systemic interactions of same-sex loving
relationships.
Keywords: positive psychology, family resilience,
nonheterosexual, LGBTQ, Walsh, optimism, positive
emotions
Whereas the vast majority of researchers have centered on
understanding the role emotions play in pathology, dysfunction,
and disorder (Ong, Bergeman, Bisconti & Wallace, 2006),
positive
psychologists have focused on how emotions and protective fac-
tors contribute to the flourishing of individuals and societies
(Seligman & Csikszentmihalyi, 2000). Rejecting the deficit-
based
models underlining normative analyses, behavioral problems
and
mental illness, this relatively new branch of psychology has
dem-
onstrated interest in understanding how individuals respond suc-
cessfully to adversity, trauma and tragedy. Through the explora-
tion of “what works,” “what is right,” and “how people manage
to
improve their lives” (Sheldon & King, 2001, p. 216), positive
psychologists contribute to our existing knowledge regarding
how
positive emotions help us adapt during times of stress. Within
the
wide range of adaptive human characteristics explored in their
studies, the psychological concept of resilience has received
sig-
nificant attention that has translated into an impressive and
exten-
sive body of scholarly literature (Luthar, 2006; Masten, 2001).

As
a result of their strong contribution in the area of psychological
resilience, positive psychologists claim that their empirical
find-
ings have effectively brought to light the developmental
strengths
and resourcefulness of their participants (Aspinwall &
Staudinger,
2003; Keyes & Haidt, 2003; Peterson & Seligman, 2004; Selig-
man, Reivich, Jaycox, & Gillham, 2007). Pursuing their claim
further, we have found numerous positive psychology studies
reporting on the resilience of a variety of populations including
trauma victims (Bonanno, 2008; White, Driver, & Warren,
2008),
college students (Mak, Ng, & Wong, 2011), the military
(Cornum,
Matthews, & Seligman, 2011; Reivich et al., 2011), Jews and
Arabs (Hobfoll et al., 2009), injury patients at rehabilitation
clinics
(Quale, & Schanke, 2010), men (Hammer & Good, 2010), and
many more. However, some critics have pointed out that this
far-reaching literature on resilience has failed to include the
voices
of nonheterosexual families (Meyer, 2003; Torres, 2011).
Further,
the focus in positive psychology has remained on individuals,
not
on families. Because nonheterosexual families face unique chal-
lenges that heterosexual families do not (e.g., heterosexism and
sexual prejudice), it would be inappropriate to assume that
positive
psychology literature on resilience, which has mainly focused
on
heterosexual individuals, helps advance our understanding
regard-

ing the systemic strengths that enable thriving in overlooked
lesbian, gay, bisexual, transgender, or queer (LGBTQ) families.
Addressing overlooked LGBTQ and systemic factors in positive
psychology, this article draws on family resilience literature and
LGBTQ literature to theorize a systemic positive psychology
framework for working with nonheterosexual families. Hoping
to
help practitioners understand, elicit, and amplify the systemic
strengths that enable thriving in LGBTQ families, we developed
the LGBTQ relationally based positive psychology framework.
This framework integrates positive psychology’s strengths-
based
perspective with the systemic orientation of Walsh’s (1996)
family
resilience framework along with the cultural considerations pro-
posed by LGBTQ family literature. We theorize that the LGBTQ
relationally based positive psychology framework takes into
con-
sideration the sociopolitical adversities impacting
nonheterosexual
families and sensitizes psychologists, including those working
in
organized care settings, to the systemic interactions of same-sex
loving relationships. Our framework proposes that
understanding
This article was published Online First March 23, 2015.
Daniela G. Domínguez, Monte Bobele, Jacqueline Coppock, and
Eze-
quiel Peña, Department of Psychology, Our Lady of the Lake
University.
Correspondence concerning this article should be addressed to
Daniela

G. Domínguez, 590 N. General McMullen, San Antonio, TX
78228.
E-mail: [email protected]
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Psychological Services © 2015 American Psychological
Association
2015, Vol. 12, No. 2, 177–185 1541-1559/15/$12.00
http://dx.doi.org/10.1037/a0038824
177
mailto:[email protected]
http://dx.doi.org/10.1037/a0038824
the systemic interactions of LGBTQ families as well as the
socio-
cultural and political context in which those interactions take
place, can help practitioners improve the quality of health care
services delivered and can help offer clients a valuable
treatment
experience. Practitioners working in organized care settings
often
need to collaborate with clients who feel unheard and misunder-
stood by health professionals. According to researchers,
working

with the larger family system can help offer clients support and
can
assist practitioners in the development of a treatment plan that
promotes family involvement as clients work through
noncritical
or critical situations (de Jong & Schout, 2011). Unlike
traditional
approaches used in public mental health that often center on the
individual, our framework is driven by the entire family system.
In
this article, we hope to encourage practitioners to explore the
resources and strengths that have enabled LGBTQ families to
overcome stressors including heterosexism, sexual prejudice,
and
institutional discrimination, among others. In a post-Defense of
Marriage Act (1996) world in which federal health care benefits
have been extended to same-sex married couples, their children,
and stepchildren, organized care settings will likely notice an
increase in the demand for public mental health services from
nonheterosexual families (Respect for Marriage Act, 2013).
With
that in mind, health professionals interested in increasing
customer
satisfaction and building an affirming practice for LGBTQ fami-
lies, should consider incorporating the LGBTQ relationally
based
positive psychology framework into their clinical practice. Our
resilience framework promotes an inclusive definition of
“family”
and encourages practitioners working in public service settings
to
create a warm therapeutic environment that celebrates same-sex
loving relationships. Our framework utilizes a culturally
sensitive
approach that may help clients who have had negative
experiences

with organized care settings and their staff in the past, feel con-
nected, valued, and supported.
Literature Review
Although lesbians and gay men report relatively high utilization
rates for counseling and psychotherapy services (Liddle, 1997),
research “addressing the care of LGBT populations in the public
sector appears to be nonexistent” (Hellman & Drescher, 2005, p.
16). In addition, recent studies demonstrated that both rural and
urban providers in the public sector lack adequate training and
competency on LGBTQ issues (Warren & Smalley, 2014). Re-
searchers argue that there is an absence of coordinated funding
opportunities in the public sector to support research and
practice
on LGBTQ mental health issues (Hellman & Drescher, 2005).
According to Semp (2011), the limited research on public
mental
health services for the LGBTQ population suggests that profes-
sionals working in the public sector often ignore their clients’
sexuality. In addition, studies suggested clients receiving public
mental health services reported feeling uncomfortable
disclosing
their sexual orientation, even when they believe their sexuality
is
relevant to their mental health concerns (Semp, 2011). With the
former in mind, many psychologists have recognized the need
for
culturally sensitive psychological services to help the LGBTQ
community. Maylon (1982) asserted the necessity for gay
affirma-
tive therapy, an approach which “represented a special range of
psychological knowledge which challenges the traditional view
that homosexual desire and fixed homosexual orientations are
pathological” (p. 69). His approach encouraged the development

of literature highlighting gay affirmative practice (GAP) within
the
fields of psychology and social work (Appleby & Anastas,
1998; Crisp,
2007; Crisp, 2006; Davies & Neal, 1996, 2000; Hunter &
Hickerson,
2003; Hunter, Shannon, Knox, & Martin, 1998; Neal & Davies,
2000;
Tozer & McClanahan, 1999; Van Den Bergh & Crisp, 2004).
Several scholars have discussed guidelines for practicing GAP
such as abiding by one’s professional code of ethics, not
assuming
the client is heterosexual, becoming attentive and mindful to
different “coming out” stories, and practicing awareness of our
own heteronormative and gender normative assumptions, among
others (Appleby & Anastas, 1998; Hunter et al., 1998).
Likewise,
Davies and Neal (1996, 2000; Neal & Davies, 2000) declared
that
a gay affirmative approach does not require a distinct set of
skills
and techniques, it simply requires treating LGBTQ individuals
with respect, fairness, compassion, and as having value. Alto-
gether, the premises of GAP demonstrate a commitment to
coun-
teracting the effects of homophobia and heterosexism by calling
practitioners to surpass a neutral position by “celebrating and
advocating the validity of lesbian, gay, and bisexual persons
and
their relationships” (Tozer & McClanahan, 1999, p.736).
Although
psychologists have contributed research on the positive aspects
of
LGBTQ identity within the past decade (Horne, Puckett, Apter,
&
Levitt, 2014), there is an undeniable dearth in literature

highlight-
ing a strengths-based framework for working with LGBTQ
fami-
lies seeking psychological services.
Some researchers have recognized the urgency for practitioners
to sustain a strengths-based perspective when working with the
LGBTQ population (Appleby & Anastas, 1998; Butler, 2004;
Crisp, 2007; Van, Wells, & Boes, 2000). For example, Crisp
(2007) and Butler (2004) suggest practitioners help sexual
minor-
ities draw upon their assets and strengths to assist them in over-
coming their presenting concerns. Nevertheless, this literature is
limited to the field of social work, in turn, restricting the
general-
izability of its implications to psychological services delivered
in
organized care settings. Thus, it remains that few resources are
available to assist psychologists providing managed care, in
their
application of strengths-based approaches to help
nonheterosexual
families succeed. Strengths-based approaches are especially im-
portant, given that LGBTQ clients are often portrayed in the
literature as wounded individuals whose victimization has pro-
duced deficits in their mental and physical health, academic
achievement and identity development (Espelage & Swearer,
2008; Russell & Richards, 2003). Torres (2011) argued this
deficit
view has evolved because resiliency research is dominated by
heterosexist ways of knowing that neglect “the lives, voices,
and
developmental successes of same-sex attracted individuals”
(p. 12). Scholars argue that although earlier research in
counseling
psychology has explored the intersection of strengths and

culture,
positive psychology researchers have been slow in their
contribu-
tions of LGBTQ research (Lopez et al., 2002). Although
positive
psychologists have strong convictions to help at-risk
populations
overcome life’s obstacles, our review found few research
studies
conducted by positive psychologists looking into the protective
factors that help nonheterosexual families remain hopeful, opti-
mistic and confident in the midst of difficult challenges. The
question, “What makes life worth living for nonheterosexual
fam-
ilies?” is rarely addressed by positive psychologists.
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178 DOMÍNGUEZ, BOBELE, COPPOCK, AND PEÑA
Clearly, positive psychologists are devoted to building a social
science that promotes families that allow children and
communi-
ties to flourish (Positive Psychology Center, 2007). Considering
the invisibility of sexual minority topics in their research, what

is
still far from clear is whether positive psychology’s definition
of
“family” is inclusive of nonheterosexual families. This review
points to a gap in resiliency research that rarely addresses how
nonheterosexual families engage in creative behaviors and
cogni-
tive flexibility to facilitate their life pursuits. Practitioners
working
in organized care settings should be cautious not to overlook the
culture-specific stressors faced by LGBTQ families as this may
compromise the therapeutic process and therapeutic outcome.
We
encourage practitioners providing public mental health services
to
ask their LGBTQ clients the question, “What has helped your
family succeed in the midst of difficult challenges?” We believe
that the answer to this question may help LGBTQ families
arrive
at systemic solutions to their problems. Practitioners interested
in
exploring the underlying resiliencies and resources that have
helped their LGBTQ clients and their families succeed in the
face
of hardship, may find our framework to be a helpful resource.
Positive Psychology Research on Resilience
Resilience is an adaptive and dynamic quality found among all
humans that enables them to cope and thrive despite adversity
(Garmezy & Rutter, 1983; Luthar & Wong, 2003; Masten,
2001).
In the field of positive psychology, two camps have emerged
that
view human strengths differently. One camp proposes that
strengths are universal and culture-free (Peterson & Seligman,

2004; Seligman & Csikszentmihalyi, 2000), and the other
proposes
that strengths are manifested differently depending on the
socio-
cultural context (Constantine & Sue, 2006; Snyder & Lopez,
2007). The Oxford Handbook of Positive Psychology (Lopez &
Snyder, 2011) contains a number of research studies conducted
by
the first and second camps. No culture-embedded models (the
second camp) presented in this handbook addressed the resilient
qualities presented by LGBTQ families. In contrast, a chapter
titled “Positive Psychology and LGBTQ Populations” (Horne et
al., 2014) in the book Perspectives on the Intersection of Multi-
culturalism and Positive Psychology by Pedrotti and Edwards
(2014) offers a review of positive psychology research on the
strengths of LGBTQ individuals, relationships, and families.
Their
review suggested that LGBTQ people have “considerable
strengths in
terms of self-definition, self-determination, perspective-taking,
com-
munity building, and creating family networks and
communities”
(p. 199). Our framework integrates some of the most prominent
research conducted by positive psychologists on the theory of
learned optimism, the broaden-and-build theory, and literature
on
the positive identity in LGBTQ individuals, and captures how
practitioners in the public sector can help LGBT families utilize
their systemic strengths, assets, and resources to boost their
resil-
ience. The following section reviews the theory of learned opti-
mism, the broaden-and-build theory, and literature on LGBTQ
positive identity.
Seligman’s Model

Seligman’s culture-free perspective on resilience suggests that
there are 24 personal strengths and universal attributes that can
be
found across cultures (Peterson & Seligman, 2004; Snyder &
Lopez, 2007). His empirical work on resilience (2006) has led
to
a focus on teaching applied strategies designed to help all
people
from all cultures challenge adversity. He and his colleagues
main-
tain that psychology can “transcend particular cultures and
politics
and approach universality” (Seligman & Csikszentmihalyi,
2000,
p. 5). Seligman’s (2006) theory of learned optimism proposed
that
people could learn how to become optimistic if they are taught
how to challenge negative self-talk. Seligman and others
theorize
that resilience is a protective factor that can be learned from
experts in the field of positive psychology, including those pro-
viding public mental health services. They contend that
individuals
who master these techniques are more apt to rise above
debilitating
pessimism and depression. Focusing on the factors identified by
Masten and Reed (2002) (e.g., optimism, problem solving, self-
efficacy, self-regulation, emotional awareness, flexibility,
empa-
thy, and strong relationships), Reivich and colleagues (2011)
pro-
mote the use of the Penn Resiliency Program, which trains
individuals to effectively challenge their unhelpful thoughts
using

cognitive– behavioral principles. Contrary to Peterson and
Selig-
man’s (2004) understanding that strengths are universal,
members
of the second camp argue that cultural norms construct what is
considered to be “strength,” “weakness,” “the good life,” and
the
“good person” (Pedrotti, Edwards, & Lopez, 2009, p. 49). They
propose that overlooking culturally specific strengths is
problem-
atic. Even more problematic is overlooking the inner strengths
of
historically “overpathologized populations” (Lopez & Snyder,
2011, p. 172).
Our framework proposes that Seligman’s research appears to be
culture bound in its efforts to teach individuals, including
nonhet-
erosexual family members, strategies that have not been signifi-
cantly studied or proposed to be effective with a large LGBTQ
sample. Seligman’s emphasis on “teaching” and his position on
strengths-promotion suggest that positive psychologists can,
through innovative strategies, inform clients about stress reduc-
tion. Nevertheless, stigma, discrimination and violence against
LGBTQ families create additional stresses beyond what are
typi-
cally experienced by heterosexual families (Herek, 2009, 2010).
The cognitive– behavioral principles found in Seligman’s resil-
ience model are proposed as potentially helpful to all
individuals
and across all cultures. Yet it remains to be demonstrated that
they
be useful when working with families in general and nonhetero-
sexual family systems in particular.
The Broaden-and-Build Theory

Barbara Fredrickson (2000), a positive psychologist, introduced
the broaden-and-build theory of resilience. Fredrickson (2001)
claimed that when people are exposed to negative experiences
(e.g., failure) they tend to narrow their focus onto the problem.
When this narrowing of focus occurs, they are unable to access
their full cognitive potential. Conversely, when people are
exposed
to positive emotions (e.g., joy, curiosity, hope and
contentment), it
strengthens their cognitive associations, broadens their attention
and empowers them to implement creative and positive
solutions
to their problems. Her theory proposes that resilient individuals,
more than the general population, possess creative and flexible
problem solving skills that help them practice the benefits of
positive emotions to their advantage. She suggests that
discovering
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179LGBTQ RELATIONALLY BASED POSITIVE
PSYCHOLOGY
positive meaning within adversity is one way that resilient indi-

viduals demonstrate their strength. Given that this theory finds
a
relationship between discovering positive meaning within
adver-
sity and being resilient, we pose these questions—“Are LGBTQ
individuals resilient because they somehow find positive
meaning
in the context of traumatic experiences such as hate crimes, bias
crimes and bullying?” Or, “Are LGBTQ individuals able to
bounce
back because they are forced to adjust to their existing environ-
ment in order to survive?” Or, “Are both valid propositions?”
Fredrickson’s findings highlight the importance of building
posi-
tive emotional experiences into people’s everyday lives;
however,
her theory is unable to account for how LGBTQ families
manage
to move forward while simultaneously experiencing negative
emo-
tions within the discriminatory context in which they are
situated.
John Chambers Christopher (2011) argues that positive psychol-
ogy models such as Fredrickson’s require a move beyond objec-
tivism and relativism and a move toward a framework that
under-
stands that reality is socially constructed across and within
cultures. A move toward a culturally embedded positive
psychol-
ogy framework that addresses how families with multiple salient
identities (e.g.- racial minority nonheterosexual families,
nonhet-
erosexual binational families, lesbian-headed families) manage
to
experience positive emotions while coping with threatening
envi-

ronments. We propose that the use of a culturally embedded
positive psychology is imperative in the public sector, as practi-
tioners work to understand how nonheterosexual families,
includ-
ing LGBTQ families of color, mobilize their protective systems
while navigating their multiple identities across cultures.
Research on the Positive Identity of
LGBTQ Individuals
Although Fredrickson (2000) has addressed positive meaning as
a sign of resilience in the broaden-and-build theory, some re-
searchers are further narrowing the existing gap in positive psy-
chology literature on LGBTQ mental health by investigating the
lives and identities of nonheterosexuals. In 2008, a positive
psy-
chology online survey found that over 500 gay and lesbian
partic-
ipants considered the following to be positive aspects of having
a
nonheterosexual lifestyle: belonging to a community, creating
families of choice, forging strong connections with others,
serving
as positive role models, developing empathy and compassion,
living authentically and honestly, gaining personal insight and
sense of self, being involved in social justice and activism,
being
free from gender-specific roles, exploring sexuality and
relation-
ships, and enjoying egalitarian relationships (lesbian
participants
only; Riggle, Whitman, Olson, Rostosky, & Strong, 2008).
Other
studies in which LGBTQ mental health and positive psychology
converged included topics like the development of a positive
self-identity and self-worth among “rural lesbian youth” (Cohn

&
Hastings, 2010), the positive aspects of a bisexual self-
identification (Rostosky, Riggle, Pascale-Hague, & McCants,
2010), and the resiliency factors reported by LGB individuals in
response to anti-LGB political campaigns and legislation
(Russell
& Richards, 2003). Butler (2004) posits that sexual minorities
possess exceptional resiliency and specific strengths that help
them
overcome these obstacles. She asserts that LGBTQ individuals
develop coping skills through the process of accepting their
sexual
identity and through the coming out process. Additionally,
sexual
minorities gradually experience less stigma, greater flexibility,
and
are able to better manage social perception because of the diffi-
culties they so often face (Butler, 2004). Although these studies
did take into consideration contextual factors specific to gays,
lesbians and bisexuals, they primarily focused on individuals’
perceptions of their growth-fostering connections rather than on
the systemic interactions that protected their families from
crisis or
breakdown. Whereas the former research centered on
understand-
ing individuals’ perceptions of their growth-fostering
connections,
our family driven framework, focuses on the systemic
interactions
that help LGBTQ families thrive.
Christopher and Hickinbottom (2008) suggest that the current
paucity of literature that takes into account systemic factors has
resulted from positive psychologists’ focus on the Western
concept

of “self.” Hence, positive psychologists subscribe to an
individu-
alistic framework and “insulate themselves from reflecting criti-
cally on their work” (p. 563) as it relates to systemic, cultural,
and
other diversity factors. We find that Walsh’s (1996) family
resil-
ience framework may offer a way to integrate these factors. Her
resiliency framework focuses on healthy family functioning and
offers a relevant and systemic alternative to research focused
solely on the stressors that nonheterosexual individuals endure.
By and large, resilience as a mechanism to thrive in the face of
adversity has undeniable prominence in positive psychology
liter-
ature. Given the problems sexual minorities contend with on a
day
to day basis, strengths-based approaches that emphasize
resilience
have the potential to be beneficial to LGBTQ individuals’ well-
being. Although there is great acceptance for LGBTQ
individuals
and relationships in some sectors of society, considerable
amounts
of inequality, discrimination, heterosexism, and homophobia
con-
tinue to impact nonheterosexual families receiving services in
organized care settings. To better serve LGBTQ families
seeking
psychological services in the public sector, an approach that
looks
at resilience within a systemic family context is imperative. One
distinct attempt at highlighting the importance of resilience
from a
systemic perspective is found in Walsh’s (1996) relationally
based

family resilience framework. In the following section, we will
describe Walsh’s framework in detail.
Resilience Focused on Systems: A Much Needed
Source in Positive Psychology
Walsh’s (1996) relationally based family resilience framework
maintains that stressful events impact the entire family and
create
a ripple effect on everyone’s relationships. Family resilience
the-
ory goes beyond current positive psychologists’ research by fo-
cusing its attention on the family. Walsh’s theory proposes that
family members already have the necessary tools to reduce their
distress and to strengthen their relationships with others. More-
over, this framework openly challenges the myth that the
standard
North American family (White, intact nuclear family headed by
father) is healthier than any other family constellation (Smith,
1993), and openly welcomes diverse family arrangements.
Walsh
(2003) argues that we need to move beyond the “myth of the
self-reliant nuclear family household by expanding attention to
the
multiple relationships and powerful connections” that exist in
today’s world (p. 47). Recently Walsh (2011) conceptualized
the
notion of “family” as a social construction with multiple
meanings,
relational patterns and unique caring bonds. In short, her frame-
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180 DOMÍNGUEZ, BOBELE, COPPOCK, AND PEÑA
work focuses on (a) family strengths under stress, (b) multiple
realities for diverse families, (c) the sociocultural context in
which
people are situated, (d) the belief that families have the
resources
to recover and grow from adversity, and (e) the …
Journal of Homosexuality, 62:394–426, 2015
Copyright © Taylor & Francis Group, LLC
ISSN: 0091-8369 print/1540-3602 online
DOI: 10.1080/00918369.2014.977115
Clinicians’ Perspective of the Relational
Processes for Family and Individual
Development During the Mediation of Religious
and Sexual Identity Disclosure
CHANA ETENGOFF, PhD
Department of Psychology, Barnard College, Columbia
University, New York, New York, USA
COLETTE DAIUTE, PhD
Department of Psychology, Graduate Center of the City

University of New York, New York,
New York, USA
Although the psychological literature regarding gay men from
religious families is continually expanding, it is also limited in
that few studies focus on the use of therapy in the negotiation of
the interrelated systems of religion, sexuality, and family.
Utilizing
a cultural historical activity theory-based process of analysis,
this
study focuses on the narratives of 12 clinicians discussing 230
con-
flicts and how those conflicts are mediated in both productive
(e.g.,
seeking secular support) and unproductive ways (e.g., bringing
one’s son to an exorcist) by gay men and their religious families
independent of and at the advice of their therapists.
KEYWORDS therapy, clinical practice, gay, religious, conflict,
sociocultural
American politics today are at a crossroads in terms of the
campaign for
sexual minorities’ legal rights. While there have been many
recent changes
expanding sexual minority rights, such as the 2011 repeal of the
military’s
“Don’t Ask, Don’t Tell” policy and the Supreme Court’s 2013
ruling that the
federal Defense of Marriage Act is unconstitutional, many
issues continue to
be debated. This sociopolitical context is embedded within a
religious one,
Address correspondence to Chana Etengoff, Department of

Psychology, Barnard
College, Columbia University, 3009 Broadway, New York, NY
10027, USA. E-mail:
[email protected]
394
mailto:[email protected]
Clinicians’ Perspective 395
as the majority of Americans are raised in families in which
religious beliefs
are present (Lease & Shulman, 2003), and specific aspects of
religiosity have
been inversely correlated with sexual minority acceptance
(Adamczyk & Pitt,
2009; Fisher, Derison, Polley, & Cadman, 1994) as well as with
attitudes
toward sexual minority legal rights (Hooghe, Claes, Harell,
Quintelier, &
Dejaeghere, 2010; Oldmixon & Calfano, 2007).
This relation between religion and sexual minority acceptance
was
recently highlighted by Texan governor and Republican
nominee hopeful,
Rick Perry. In his infamous 2012 political advertisement, Perry
stated, “I’m
not ashamed to admit that I’m a Christian. But you don’t need
to be in the
pew every Sunday to know there’s something wrong in this
country when
gays can serve openly in the military but our kids can’t openly
celebrate
Christmas or pray in schools.” Within this narrative, Perry

publically sup-
ported a cultural narrative suggesting that religion and sexual
orientation
diversity are incompatible and that alternative assertions
encroach on oth-
ers’ religious freedoms. In this article, we suggest that
individual and familial
development is situated within such sociocultural narratives and
the methods
by which they navigate the culturally constructed polarization
between reli-
gion, sexuality, and family values. For example, extant research
suggests
that the majority of sexual minority persons from religious
backgrounds
have reported experiencing a level of conflict between their
sexual orien-
tation and religion. For example, Dahl and Galliher (2009)
found that 60%
of disclosed sexual and gender minority participants (18–24
years) reported
some degree of religious conflict, and 40% of all participants
reported that
they were unable to integrate their sexual and religious
identities (Dahl &
Galliher, 2009). Similar results were found for an older
population as well
(18–65 years, M Age = 35), with 64% of sexual minority
participants indi-
cating that they experienced a conflict between their sexual
orientation and
religion (Schuck & Liddle, 2001). Within a Jungian and
spiritually integrated
psychotherapy perspective, self-related conflicts are particularly
problematic
as the most fundamental human drive is the need to integrate the

multiple
facets of the self (Jung, 1938). In a similar vein, sociocultural
theory suggests
that human development is situated within our efforts to
construct and make
sense of our roles within conflicting and interacting activity
systems (i.e.,
Vygotsky, 1978).
The present study illustrates the significance of applying
Vygotsky’s cul-
tural historical activity theory (1978) and the theory of
relational complexity
(Daiute, 2012) to the study of family and individual therapy
regarding the
interaction of sexual orientation, religion, and family relations.
Within this
lens, the therapeutic process is positioned as an activity-based
process that
occurs and is subject to change in association with the complex
demands
of dynamic socio-relational contexts. Thus in this article
possible solutions
to familial conflicts surrounding issues of sexuality and religion
are under-
stood to be actively constructed by both the client and therapist
to mediate
396 C. Etengoff and C. Daiute
(modify) the use and purpose of cultural tools (e.g., biblical
texts and values)
via activities (e.g., therapy, religious institutional engagement,
constructing

new narratives) in an effort to meaningfully address the
demands of chang-
ing contexts and sociocultural environments (e.g., more
permeable religious
environments, gay rights).
Therefore, the focus of this article includes the study of both
social–
relational dynamics and individual subjectivities and capacities.
Given this
study’s unique focus on the sociocultural contexts of
interpersonal relations,
this study specifically focuses on clinicians who worked with
gay men as
prior research has indicated that the disclosure process may
significantly
vary across sexual minority groups (Rodriguez & Ouellette,
2000), that men
and women often occupy different public roles from each other
within the
structural location of religious institutions (Glassgold, 2008;
Ozorak, 1996),
and that biblical prohibitions concerning gay men and lesbians
differ as well
(Greenberg, 2004).
CONFLICTS WITHIN THE INTERACTING SYSTEMS OF
RELIGION,
SEXUALITY, AND FAMILY
Religious and familial activity subsystems are often highly
interrelated, and,
as such, religious orthodoxy is likely to play a significant role
in familial
responses to a relative’s sexual orientation disclosure and their
conflicts

(Etengoff, 2013; Mahoney, 2010; Walsh, 2008). For example, a
recent nar-
rative study focusing on the post-disclosure familial conflicts of
23 gay men
from fundamental Christian and Orthodox Jewish backgrounds
found that
74% of participants reported that their familial conflicts were
situated within
religious contexts (Etengoff, 2013). Moreover, researchers
suggest that while
religious coping can successfully mediate cultural and familial
conflicts (e.g.,
religiously reframing event, person, or the sacred to improve
relations),
religion is often used in relationally harmful ways as well
(Brelsford &
Mahoney, 2009; Etengoff & Daiute, 2014; Pargament, 1999).
For example,
religious Christians have reported incorporating God into their
familial con-
flicts even at the cost of resolution failure (Butler & Harper,
1994). Brelsford
and Mahoney (2009) defined this maladaptive process by which
“God/faith
is positioned as an ally against [the] other party” as theistic
triangulation
(Brelsford & Mahoney, 2009, p. 291).
Although research indicates that more religious groups place a
higher
value on the importance of family than less religious groups
(Jensen &
Jensen, 1993; Newman & Muzzonigro, 1993; Mahoney, 2010),
more religious
families also report encountering greater difficulty in accepting
their gay rela-

tive than less religious families (Conley, 2011; Freedman, 2008;
Kubicek et al.,
2009; Newman & Muzzonigro, 1993; Schnoor, 2003). For
example, Newman
and Muzzonigro’s (1993) analysis of 27 gay adolescents and
emerging adults’
Clinicians’ Perspective 397
questionnaire data indicate that gay youth from more traditional
and reli-
gious families felt less accepted during their disclosure process
than gay
youth from more secular families. Such negative coming-out
responses from
religious relatives frequently impact the mental health of the
sexual minority
relative, highlighting the importance of engaging both the
systems of family
and religion in clinical and community intervention settings
(Ryan, Russell,
Huebner, Diaz, & Sanchez, 2010).
A CRITICAL REVIEW OF PRIOR CLINICAL RESEARCH
Despite a growing body of research regarding gay men from
religious
backgrounds, there is limited knowledge concerning whether the
issues
explored by researchers are additionally being discussed during
therapy and,
if so, how these issues are being addressed (e.g., Freedman,
2008; Kubicek,
McDavitt, Carpineto, Weiss, Iverson, & Kipke, 2009; Schuck &

Liddle, 2001).
For example, although Dahl and Galliher (2009) reported that
13% of the
63 sexual and gender minority participants that integrated their
sexual and
(primarily Christian) religious identities found counselor
support to be bene-
ficial, there was no discussion as to how those issues were
navigated during
the course of therapy.
Furthermore, few studies include clinicians’ perspectives
regarding their
role in the therapeutic process for gay men and their religious
family mem-
bers, although clinical recommendations are often provided
(e.g., Phillips &
Ancis, 2008). Those studies that do include clinicians’
perspectives are often
quantitatively focused on how clinicians’ religious attitudes and
sexual orien-
tations influence the therapeutic process and client relationship
(e.g., Balkin,
Schlosser, & Levitt, 2009; Green, Murphy, & Blumer, 2010;
Stracuzzi, Mohr, &
Fuertes, 2011) as opposed to a pragmatic discussion of the
conflicts encoun-
tered around issues of religious involvement and the methods
and strategies
that counselors employ when working with sexual minority
clients (Bozard
& Sanders, 2011). For example, Balkin et al. (2009) found that
counselors
with more rigid religious attitudes were more likely to exhibit
homopho-
bic attitudes. However, the question of exactly how these

religious and
homophobic attitudes influenced the counseling process was not
explored.
In addition, the extant literature that does include clinical
perspectives is
often limited to case studies (e.g., Glassgold, 2008; Haldeman,
2004; Tan &
Yarhouse, 2010), individual therapists’ perspectives (e.g.,
Mark, 2008; Paul,
2008), discussions of non-empirically tested methods of
intervention (e.g.,
Bozard & Sanders, 2011; McGrady & McDonnell, 2006), and
clinical pop-
ulations of a single faith (e.g., Mark, 2008; Pope, Mobley, &
Myers, 2010).
Indeed, most studies on religion and psychotherapy in general,
as well as
in terms of the sexual minority population specifically, focus
exclusively on
issues of Christian religiosity (Worthington, Kurusu,
McCullough, & Sandage,
398 C. Etengoff and C. Daiute
1996; Rodriguez, 2010). In addition, much of the extant
research focuses on
specific, segmented aspects of the difficulties encountered by
gay men from
religious backgrounds, such as how to reconcile sexual and
religious iden-
tity, without necessarily including a simultaneous discussion of
the multiple
actors and systems (e.g., family) that are a part of this
negotiation process

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