Gender Identity, Sexual Orientation, and the Evolving Discourse

A frustrated, brooding teenager vacillates between hurling insults and expressing disgust about those "gay guys at school who just walk around flaunting it," and moments later then timidly questions, "Is it okay if I like boys and girls? I mean, like, I'm not like that but it's okay if I just like boys, right?"

An elementary student confidently shares about her day, filling her parents in on what she learned, who she played with, and about the girl in her class on whom she has a crush.

A heterosexual married couple works through the recent disclosure of the husband to his biologically female, heterosexual partner that he no longer identifies as a man despite having done so throughout their relationship spanning two decades. This partner now identifies as a lesbian female...

The topics of gender identity and sexuality are alive and well, and currently are very prominently present in the therapeutic space in a variety of ways. Despite there being many more resources and much more information circulating, many intelligent, high-functioning, and healthy individuals are choosing to allow therapy to be a viable self-care tool as well.

One of the most significant trends in my 3 therapeutic practices currently is toward increasingly more individuals of all ages seeking support and information to understand the implications of their thoughts and feelings around sexual orientation and/or gender. Young children, teens, and adults are proactively seeking out therapy to gain tools for processing gender identity/sexual orientation, learning about terminology, finding out how to connect with peers at a similar point in their development, and learning to share about this with friends and family in a way that is most likely to feel safest and most in sync with their personal developmental timeline. In addition to the individuals themselves, more and more caring, well-intentioned parents are seeking greater knowledge and more tools to support their children and teens who are disclosing information about their gender identity and/or sexual orientation. Among the most frequent questions posed by those coming into therapy include, "What do all of the words/letters mean in LGBTQ(IA)?" Often there are specific terms that feel unfamiliar, or seem a bit newer to the discourse about which there are questions. Typically there is also confusion about the differences among biological sex, sexual orientation, and gender identity.

Included here is a brief "cheat sheet" containing some language that may be useful to aid in healthy discussion about this topic (I included these specific terms because they are the ones I am most often asked about in therapy). Below those definitions you will find additional tools and information about next steps for individuals or families, and more.

- What are Some of the Key Terms? -

* Note: Though this list is not exhaustive and not intended to be a complete dictionary of terms by any means, we hope this may be a helpful tool. It is important to acknowledge that even now as you are laying eyes on this entry the discourse is continuing to evolve. Though some find this constant development overwhelming, the potential benefit is that with change comes ever-growing accuracy of expression, sensitivity and empowerment, and such development is allowing modern culture to have more productive conversations!

So... what does LGBTQIA stand for again??? Often this is an acronym for (though particularly the Q, I, and A can signify other terms): Lesbian, Gay, Bisexual, Transgender, Questioning (or Queer), Intersex, Asexual.

Ally: Generally a "strait"/heterosexual, cys-gendered individual who advocates for the LGBTQIA community. Not only do many participate in acts of advocacy by working toward equitable treatment of the Community, but allies generally also uphold principles of respect and kindness toward others.

Asexual: Denotes disinterest in sexual intimacy with others (though there may be interest in romantic involvement with others in some instances). Disinterest may fall somewhere on a spectrum spanning little interest, interest limited to certain people or situations, or to total absence of interest.

Binary: The idea that gender is binary refers to the idea that gender either includes simply male and female. All people are believed to fall into one of these two categories.

Bisexual: Generally describes people who are attracted (physically, emotionally, sexually, romantically) to members of their same and of the other sex/gender. Implied here is the notion that there are only two sexes, two genders (see "binary," see "pansexual").

Cisgender: Individuals are generally thought of as Cis- or Transgendered; people classified as cisgender have biological sex identities and assigned gender identities that match. A biological female, for instance, is classified as of the female gender when she is born. When these are seemingly the same this is considered cisgender.

Gay (preferred over "homosexual," which is considered derogatory due to historical significance): Generally refers to men who are primarily attracted (physically, emotionally, sexually, romantically) to other men, though in general refers to individuals who are attracted to members of the same sex and/or gender. (*Note: There is a difference between sexual behavior and identity; that is, some men who engage in sexual behavior with other men identify as straight. MSM is sometimes used to indicate "men sleeping with men").

Gender: Feels tricky because it is often confused with "Sex"; however, gender is a social construct that includes societies expectations about a person's traits, speech, actions, clothing, and so forth. This is what society thinks men and women "should" do/be/act, etc.

Gender Identity: This is the sense we carry from early in life about how we authentically express our gender; when the outward expression of gender identity (through behavior, grooming, and so forth) accurately reflects the internal experience, far less suffering takes place.

Genderqueer: Those who identify as genderqueer do not see themselves as "gender conforming," often see gender identity as fluid, and may identify as both male and female, neither male nor female, may vacillate between these gender identities, or may not subscribe to any of these gender identities. Individuals may not name their gender, may not see it as binary, etc.

Genderfluid: Genderfluid individuals generally identify more as female or male increasingly at various times, and this identification as male or female fluctuates. This fluidity is characteristic.

Heterosexism: Though many use the term, "homophobia," the preferred and more accurate clinical term is heterosexism. Homophobia implies an actual phobia of individuals attracted to members of the same sex; this is not the most accurate explanation. Instead, heterosexism implies being heterosexual is preferred, and also implies negative behaviors toward, beliefs about, and feelings regarding members of the LGBTQIA community.

Intersex: People sometimes use the term "hermaphrodite" to refer to the same aspects of intersexuality; that is, intersexual individuals display secondary sexual characteristics typical of what the gender they were assigned at birth is thought to display. These may be biological or medical in origin.

Lesbian (preferred over "homosexual" - see above): Women who primarily are attracted (physically, emotionally/

romantically) to other women (See "Gay", *Note above; WSW).

Pansexual: Refers to individuals attracted to others who identify a variety of ways in terms of gender and sex/sexual orientation.

Polyamorous: Individuals are interested in non-monogamous relationships (of which there are various kinds); though not monogamous, polyamory does not imply practices of unsafe sex, but rather is always consensual and most often includes caring and connected romantic and sexual involvement.

Questioning: Sometimes considered the "Q" in "LGBTQ," though it can also stand for "Queer." This term refers to when an individual begins to examine their sexual orientation and/or gender identity more critically rather than accepting externally driven expectations typically existing from birth.

Sex (biological sex): The parts we are born with, how we are identified at birth, and what our physical parts and chromosomes dictate.

Sexual Orientation: Who you are attracted to physically, emotionally, and romantically (refrain from using the derogatory expression "sexual preference" as it implies sexual orientation is voluntary). This can include gay, lesbian, bisexual, heterosexual/"straight" and other terms that describe sexual orientation.

Transgender: An individual (who may be of any sexual orientation) who identifies as/lives as a different gender from what they initially were see as by society (that is, gender identity was assigned or presumed at birth so that it was consistent with sex/physiology of the individual). Those identifying as transgender or "trans"can identify as as male and female, or "trans" male or female, but are not limited to these (binary) gender identities.

M2F: Can refer to male-to-female transgendered individuals.

F2M: Can refer to female-to-male transgendered individuals.

Transsexual: People identify as a different gender than initially assigned and may wish to move forward with transitioning (hormonal, surgical, or other bodily changes).

(Additional sites that provide additional definitions/glossaries include:

http://itspronouncedmetrosexual.com, www.glaad.org, www.hrc.org, and more)

- Pros and cons of labels -

With so much change in classifications and terminology, why do we subscribe to labels at all? Are labels helpful or a hinderance? The short answer is probably both. Though they can be limiting, become outdated, or can even foster "Us vs. Them" mentality complete with stereotypes, labels are not inherently harmful. In fact, on the most fundamental, adaptive level we are programmed as humans to form classifications and schema to organize our world. In a primitive sense we were able to see our world as safe vs. harmful and more. Labels currently in complex society can still be a tremendous help, aiding us in understanding ourselves and others, and fostering tremendous connectedness to others as well.

- What does "Coming Out" Actually Entail??? -

Among the models describing the "Coming Out" process that applies to most people is one of the most well-known, well established. Vivienne Cass's model (1979) outlines the following stages (this is a very brief summary of each):

Identity Confusion - Person may be surprised or dismayed to consider they may not be heterosexual. This stage can include denial.

Identity Comparison - An individual starts to consider the possibility they may identify as gay, lesbian, etc. Many people at this point seek assurance this does not mean they are "entirely" attracted to members of the same sex/gender due sometimes to worries about the future and how this may change their perceived future.

Identity Tolerance - At this stage individuals typically begin to accept they likely identify as gay, lesbian, etc. and there is gradually less isolation.

Identity Acceptance - Sexual orientation is seen in a much more positive light, and there is greater hope for the future. A good deal of consideration is given to "coming out" to others, and there is gravitation toward progressively more association with others who identify as LGBTQIA.

Identity Pride - Pronounced pride about identifying as gay, lesbian, etc. so that the individual may limit interaction to others who do not identify as heterosexual. The individual may choose to immerse themselves in LGBTQIA cultural activities. People in the Pride stage often want their sexual orientation to be known and are excited to make it a focus.

Identity Synthesis - Individuals reach this stage during which sexual orientation become just one component of the integrated, complex self.

Fassinger's much more recent model has also gained momentum and been well-established.

Who Comes Out???

Many people are surprised to realize that the ‘Coming Out’ process is not limited to the LGBTQIA individual, but also to friends, family, and allies. Often individuals who identify as LGBTQIA have been conscious of thoughts and feelings connected to considering their sexual orientation and/or gender identity since very early in life. Family, friends, allies, and others close to the individual may not have considered the implications of sexual orientation/gender identity and how this connects to their relationship with the individual. Often creating greater awareness of this and validating this part of the process affecting their friends and families allows LGBTQIA individuals to feel confident and secure no matter what the initial response of friends of family members; that is, if your parents freak out when you tell them you are gay, for instance, this may be because they have not had time to work beyond the initial stage of parental Coming Out and may need time to process - it is important to try not to let this reaction wound you more than necessary or define you. Though this is the case, it is very important to keep in mind that it is crucial to provide support and caring to the individual who themselves is coming out whenever possible. Just because we are encouraging individuals who are coming out as LGBTQIA, etc. to be open to the coming out process of family/friends does not mean that family and friends do not need to be accountable for their feedback, words, and actions when this information is disclosed to them (when a loved one comes out). Some people choose to use therapy as a space in which to make this disclosure, allowing a therapist to be the initial place for family members to process their reactions so they can be their most supportive selves to their LGBTQIA loved one.

I believe I am trans; what are my first steps?

You may want to consider (without putting any unnecessary pressure on one's self) where you are in this process and what feels like the right next step. For example, not all people identifying as trans are urgently anxious to begin transitioning or even want to (medically) transition at all. Most important is being gentle and patient with yourself, and then building a support system and gaining access to resources.

My child identifies as trans (or genderfluid, etc.); what are my first steps?

Provide support and validation. Move at your child's pace when it comes to things like if and how to transition, disclosing this information to others, and deciding with whom to share. Affirm gender identity by trying not to assume pronouns, gender-related preferences (clothing, etc.), and more. Gain information and support for you, and when appropriate for your child or teen as well.

Importance of pronouns -

Keep in mind the importance of using the appropriate preferred gender pronouns (PGP's) in order to be respectful of one-another's gender identity. What do we mean by pronouns? Imagine telling someone, "He decided to stop at his place to pick up his stuff before going out." Implied is a bunch of information about the individual of whom you speak and about their gender identity, etc. We may presume from this that they are a cisgendered (binary) man. Some may even go so far as to presume even from a simple sentence like this one that the default sexual orientation of the "man" in the sentence is heterosexual as well.

Whether it is your child or anyone else it is crucial that consideration should be given to not misgendering individuals; that is, referring to a person (particularly one who identifies as not of the gender given at birth) by the wrong pronouns can be hurtful and embarrassing (or even dismissive, invalidating, or worse). It may be appropriate or even polite (different individuals feel differently about inquiring about pronouns; however, generally it is preferred by most individuals over being called by the incorrect pronouns to have the opportunity to clarify) to ask what that person prefers to be called. Since not all people identify with a binary conception of gender, he/him and she/her will not always cut it; neutral pronouns like they/them or even ze/hir and xe/xem can be a better fit. We recognize this can take time to adjust to, so please be patient with yourself and don't hesitate to offer a quick apology upon slipping up! No need to dwell; showing respect, and moving on to taking steps to avoid this misstep in the future is often a good way to go.

- Providing support -

One of the most important parts of the process of developing healthy identities (including but not limited to aspects of our identity like gender identity or sexual orientation) and of coming out, more specifically, is creating or offering a healthy support system. Every individual on the planet needs the opportunity to explore who they are throughout the developmental timeline. None of us exist in a vacuum and all progress in the healthiest manner when we have the appropriate support and caring to mirror back to us positively what we are putting out into the world. One of the biggest barriers to receiving and offering support is fear; fear of what will be lost, what the implications are of our support, and so on. However, when it comes to gender identity and/or sexual orientation, typically offering appropriate support (or accepting it) is unlikely to foster harm. On the other hand, withholding support can lead to self-destructive and self-harming behaviors in cases of extreme isolation or alienation. As the one providing support, don't forget that you also can receive support as well; organizations like PFLAG offer tools, education, and social connectedness that can be extremely helpful. Rather than invalidating your own or your loved one's declared sexual orientation and/or gender identity or referring to it as a "phase/trend," err on the side of caution and be supportive. Remember that you likely knew these things about yourself from very early in life, even if you did not have the language to describe it, and that your sexual orientation was not based on actual romantic or sexual experiences. These are part of who you are are! And sexual orientation, along with gender identity exist on a continuum or spectrum; there are many definitions or terms that can be used to describe who we are and how we feel. Most important is how an individual conceptualizes their own experiences and identity.

Visit this blog for more! Or reach out to Dr. Cynthia A. Levy at dr.cynthialevy@gmail.com, or obtain further contact information at www.beverlyhillspsychologicalcenter.com.

It is important to recognize that this is not a substitute for therapy, nor does this initiate a patient/practitioner relationship in the official sense. This should not be considered medical/clinical/therapeutic advice, but rather should be regarded simply as opinions. Should you need further assistance or intervention, you may reach out to a professional in your area. Please note: in case of a medical emergency dial 911 or go to your local emergency room.