LGBTQ+ Family Dynamics in Therapy

LGBTQ+ clients can face some unique challenges in family therapy, especially when it comes to disclosing their sexuality or gender identity, setting boundaries with intolerant family members, and helping those in their life accept who they are.

While every relationship within a family is unique, a family systems approach explores how these interrelationships can also impact the family as a whole. Consider how a conflict between a mother and father can create stress between their children, or how a rupture between a father and son can increase the stress level for everyone in the family. 

To explore this, family therapists often help their clients draw a genogram, charting not only the formation of the family, but also the network of connection, stress, rupture, and repair between each person. Identifying these dynamics can also help mental health practitioners assess the state of the family system at the onset of therapy. So let’s consider the unique challenges facing a family in crisis, a family in conflict, a family in exodus, a family in exile, a family in reformation, and a family in formation.

Family in Crisis

A family in crisis is in a state of shock. They may experience a range of surprise, anxiety, sadness, and grief, either because they don’t know how to integrate someone’s sexuality or gender identity into the family, or because they’re worried about the risks facing LGBTQ+ people. 

Psychoeducation can go a long way to dispel some of the myths around sexuality and gender identity, and there are many phenomenal books to help people find acceptance, such as:

Yet even accepting families can enter a state of crisis, especially in the wake of trauma. Consider how one study, collecting data between 2011 and 2019, found that 20 percent of LGBTQ+ high schoolers were bullied at school, with 15 percent bullied online. 

Corroborating this, the Trevor Project found that 33 percent of LGBTQ+ youth in middle school and high school were bullied in person, while 42 percent were bullied online. And children aren’t the only ones who contend with hostility, as 38 percent of LGBTQ+ employees experience harassment in the workplace—a looming fact that may contribute to why 50 percent of LGBTQ+ employees are not out to their supervisors.

Against such obstacles, it’s only natural for loving families to rally together, yet one can’t deny the increased level of stress and hypervigilance that ripples through the family system. With everyone on edge, a family in crisis may even attempt to exert control over each other in a desperate attempt to keep everyone safe. This may look like helicopter parents trying to micromanage their children with strict curfews or suffocating restrictions. Some parents may even ask their children not to talk about their sexuality or gender identity around family members who “wouldn’t understand.” 

In turn, children may ask their parents not to act a certain way around their friends, just as a spouse may ask their significant other to censor themselves at work or in specific social circles. Though the positive intent is to protect the family from harm, these control efforts create their own conflicts. It can be beneficial to explore the families’ shared values, and how they can trust each other to navigate external stressors as they arise. Likewise, community contact can go a long way to heal the family, while also building a safe and accepting neighborhood.

Family in Conflict

A family in conflict has reached a boiling point, often resulting in hostility and blame. Statements like, “I can’t believe you would do this to us” or “You’re just being selfish” can get thrown at LGBTQ+ people when they finally express their authenticity, especially if their sexuality or gender is viewed as a source of rupture. 

At this point, the initial shock of disclosure has turned into a fear of loss or a sense of disconnection, resulting in hurt and misplaced anger. Consider the father who feels estranged from his trans-daughter because he feels like he’s lost a son, or the kids who don’t know how to talk to their mom now that she’s an out and proud lesbian.

Fortunately, the emotional tension in the family may underline their desire to reconnect, even if all parties involved don’t know how. This is where family therapists can role model compassionate curiosity, since the more questions the family can ask of each other from a place of kindness, the more they understand and make room for their thoughts, feelings, and lived experience. More to the point, the more they understand each other, the more they realize that no one has actually lost anyone.   

That said, some conflicts explode when a person’s sexuality or gender identity is viewed as a moral failing or a threat to the family. Remember, it’s not the person’s gender or sexuality that’s the issue, but the mental rigidity striving to maintain a narrow concept of normality, like a person’s familial role. For more on this, see Questioning the Assumption of Normality.

If the family is willing to engage in therapy, there may be an underlying desire to repair these relationships, or at the very least, establish communication boundaries. Once again, finding common ground in shared values can build a foundation for respectful discourse, while also demonstrating how latent and blatant homophobia and transphobia create a toxic atmosphere that’s antithetical to said values. Honor, dignity, respect, loyalty, and love can all be practiced, even if one struggles to understand or accept someone’s sexuality or gender. Moreso, these values are often the key to acceptance itself.  

During these conflicts and their hopeful resolutions, family therapists must also be vigilant to protect their client’s physical and psychological safety. After all, it’s one thing to resolve conflict, and quite another to suffer through intolerance. The LGBTQ+ client may need to develop a social safety net of friends and allies to take space from their family during this process. Since each family is different, some may do well to increase contact to increase communication and empathy, whereas others may need to decrease contact for the very same reason. 

  • What increases and decreases the felt sense of pressure? 
  • Do family members rarely see each other, or do they live in close quarters? 
  • Do they under-communicate or overcommunication? 
  • Do they avoid conflict, or engage in repetitive arguments? 
  • Do they need to increase their time together, or take space to cool their jets?

Family in Exodus

A family in exodus is already in dissolution, either because the family refuses to accept the LGBTQ+ individual, or because the LGBTQ+ individual is distancing themselves to maintain their own psychological well-being. Yet a family in exodus hasn’t entirely separated. Consider the months of argument leading up to a divorce, or how teenagers can silently stonewall their parents for years until they’re old enough to move out. Returning to the genogram can be useful here, if only to identify which relationships are falling apart, and which are potentially worth salvaging.

Exodus is often initiated when a family is unwilling to address their homophobia or transphobia, or has a history of domestic abuse. Beyond physical and verbal assault, domestic abuse also includes emotional manipulation, financial manipulation, and controlling behavior that seeks to reduce, ridicule, or shame someone for their sexuality or gender identity.  

To protect the safety and well-being of the client, it may be necessary to help them create a safety plan, if not remove them from the hostile environment entirely. When working with minors, this may necessitate child services. In some unique cases, this may also mean helping a client explore their options as they seek emancipation.

Exodus often snaps like a rubber band, since family members who miss each other may attempt to reconnect, only to reignite old arguments. Relationships are rarely as dialectic as love or hate, and the sad truth is one can love a relative but still be wounded by them. By inventorying the client’s physical and emotional needs, family therapists can help them find new routes to meet those needs independent of their family. This may be as simple as going to the laundromat instead of going home to do laundry, or as complex as detangling old relationship patterns in therapy, or finding guidance, affirmation, and acceptance in a new family of choice.

Family in Exile

A family in exile does not or has not communicated with each other in some time. So estranged, clients may find themselves haunted by old memories, or by the internalized homophobia or transphobia present in their abandonment or attachment issues. They may need to address how these experiences with their family may impact their new relationships. 

Compare the different kinds of loss, and subsequent coping mechanisms, between a person who was kicked out by their family but wanted to stay, versus a person who left after years of abuse and negligence. Fears of abandonment may lead some to cling to new relationships for dear life, and others to keep a packed bag by the door.

Sometimes regret, remorse, or anger can percolate into a desire to reach out to one’s estranged family. At this junction, family therapists often implement Do Not Send letters or the Empty Chair technique as a way of practicing direct communication, value-congruent communication, or nonviolent communication, depending on the modality. 

For some, this can be enough to bring an internal sense of catharsis, yet for others, it’s just a practice run, as they may need to extend an olive branch, or finally give their family a piece of their mind. 

In either case, it’s important to help clients focus on effort over outcome, as chances are the actual conversation won’t exactly match their rehearsal. For those seeking to repair their relationship, years of estrangement don’t just vanish, and reconnection may enter a period of conflict before it can reach a resolution, albeit acceptance, forgiveness, or both.

Family in Reformation

A family in crisis, a family in conflict, a family in exodus, and a family in exile can come back together in a new way, should they make room for mutual understanding and acceptance. Yet this does necessitate a certain amount of behavioral and social change, which is why families in a state of reformation are in a place of active learning. The roles have changed, the rules have changed, and everyone has agreed to move forward peaceably, if somewhat awkwardly.

Family members of trans and nonbinary people may need time to practice new names or pronouns, and may need a certain level of patience and preemptive forgiveness as they’re bound to misspeak. Family members of gay and lesbian people may need to learn what questions or statements are inappropriate, as they challenge their own assumptions about sexual minorities. Likewise, family members of bisexual, pansexual, and even asexual people may need to adjust their understanding of sexuality and relationship dynamics.

Beyond these learning curves, families in reformation also have to adjust to much broader social dynamics, like what it now means to be a part of the LGBTQ+ community. Consider how many people take their heterosexual or cisgender privilege for granted, until intolerance and systemic oppression directly impact someone they love. Some family members may try and keep their heads in the sand, supporting their LGBTQ+ relatives in a vague and noncommittal way, whereas others can overcompensate by trumpeting the horn of social advocacy as loud as they can. In such cases, family therapy begins to resemble classic mediation, as each person conveys their intent while learning how best to communicate and support each other.

So as not to add more stress to the LGBTQ+ individual, who may or may not be in a position to provide their family this kind of guidance, family therapists can present a number of resources, like local support groups, chapters of PFLAG, and the Family Acceptance Project.

Family in Formation

A family in formation is new, either because it’s a family of choice, or because the client is about to have children of their own, via birth or adoption. LGBTQ+ clients may seek therapy at this time because they want to address their family history or detangle any lingering insecurities about starting a family of their own. 

Depending on what’s coming up for them, family therapy, individual therapy, and LGBTQ+ support groups can help a great deal to address their concerns while also leaning into their growth edge. As an example, consider how the emotional armor and rugged individualism that kept a client resilient may now get in the way of healthy new relationships. As another example, consider how a small observation like “I sound just like my parents” can unravel into anxiety, should a client worry about “making the same mistakes” or “being just like them.”

Developing community support is essential for newly formed LGBTQ+ families, not just to create a sense of belonging, but to also find compassionate, like-minded people who can offer guidance. Depending on where in the world a newly formed family is, there may also be legal issues to navigate, from discrimination against same-sex couples and their children to discrimination against transgender parents and their children. 

If legal help is required, there are many organizations by state and region that specialize in these areas, including but not limited to, Pride Legal in California, Trans LAW in Washington DC, and the LGBTQ Bar Association of Greater New York. For more guidance, it may also be helpful to review the Library of Congress’ LGBTQ+ Legal Resources: A Beginners Guide.

Finding the Right Approach

Families are not static, they naturally grow and change over time, which is why the state of a family isn’t the fate of a family. A family in crisis can find peace, just as a family in conflict can find resolution or dissolution, just as a family in exodus or exile can reconnect or set out to create new families of their own. Yet recognizing what state a family is in when starting family therapy can help mental health practitioners determine the appropriate course of action.

While maintaining a healthy family system is always optimal, the key word is healthy. At times that can look like togetherness or a reprieve from each other, and depending on the context, it may even look like dissolution. When family therapists ignore latent or blatant homophobia or transphobia within the family system or require their LGBTQ+ client to endure intolerance for the sake of “keeping the family together,” they may be subjecting their client to further psychological harm. Conversely, jettisoning a family at the first sign of intolerance, or providing them no grace period to adjust, can itself be a form of sabotage. 

This is why it’s important to consistently assess and reassess the risk of harm facing all parties involved, as conflict resolution is never easy, and intolerance can devolve very quickly into abuse.

For those who are willing to navigate conflict to repair the family system, it’s important not to dump the onus of familial growth onto a single person. LGBTQ+ people are not inherently responsible for the education of those around them and are not always equipped to help their family members navigate their own internalized homophobia and transphobia. 

Fortunately, a little patience and the aid of a well-trained family therapist can go a long way to foster both respect and acceptance. For more on navigating family states, especially when working with transgender and nonbinary clients, see ACT for Gender Identity: The Comprehensive Guide, by Alex Stitt.

Alex Stitt, LMHC

Alex Stitt, LMHC

Writer & Contributing Expert

Alex Stitt is a nonbinary author, queer theorist, and licensed mental health counselor living in Hawaii. As a proud Queer Counselor, they work to educate professionals in the mental health field interested in working with LGBTQ+ populations. Their textbook, ACT for Gender Identity: The Comprehensive Guide, demonstrates how to apply Acceptance and Commitment Therapy to gender self-actualization.