ARQ2: Question B2 - Coming out and transitioning

At about what age did you first realize you were ________?

What has it been like for you after coming out/transitioning to yourself and to others?

Relevance/intent

The blank ( _________ ) in this item (and throughout the remainder of this guide) should be filled in with the client’s response to item A2 or A3 (e.g., lesbian, queer, transgendered). If you need clarity, ask clients how they would like their identity to be addressed (e.g., a female client may want to be called a dyke or a male-to-female transsexual may want to be called a transwoman).

Coming out is a significant process in the lives of LGBTTTIQ people. It is a process, not an either/or phenomenon — it is not enough to ask if the client is “out of the closet.”

For transgendered and transsexual people, the coming-out process may also be referred to as a transitioning process.

Coming out or transitioning to certain people may result in social rejection, criticism, violence, disapproval, shock and the threat of non-confidentiality — these reactions can cause long-lasting harm to LGBTTTIQ people.

People may turn to or continue substance use to deal with the various emotions, reactions from family and peers, and social isolation that can accompany the coming-out or transitioning process. People may also use drugs and alcohol as a way to express or suppress same-sex desire or gender expression. For example, a woman may use cannabis to have sex with her husband to whom she is not attracted, or a woman may only have sex with another woman when drunk because of shame or guilt associated with internalized oppression. People can also experience increased levels of anxiety, depression and thoughts of suicide while working through the challenges of coming out or transitioning.

It is important to note that coming out and transitioning may also be a time of liberation, joy and excitement. For some people, mental health may vastly improve as they become “more of who they are.”

It is a valid choice for LGBTTTIQ people to decide when and where they come out, as they weigh the consequences. For example, someone may be out at home but not at work, or vice versa. Young people dependent on parents or caregivers may choose to wait until they are independent, fearing being rejected or kicked out of the home.

Sometimes, clients who come out or transition later in life experience a “second adolescence” in which they must negotiate interpersonal relationships and their own feelings — tasks they may not have been able to do in a heterosexist environment when younger.

Therapists/counsellors can help clients work through coming-out/transitioning issues and develop positive identities as LGBTTTIQ.

To be an ally to a client who is coming out or transitioning, you can:

provide information about coming out, to normalize the experience
provide information about community resources
pay attention both to the individual and to the social context; that is, if the client expresses fear about coming out at work, help the client identify his or her own feelings as well as provide information about societal homo/bi/transphobia and human rights in these areas.

Various coming-out models exist — these can help clinicians familiarize themselves with the experience. The Cass model for lesbians and gay men (Cass, 1979) consists of six stages:

Identity confusion — people are unsure of who they are.
Identity comparison — people identify that they are different from others.
Identity tolerance — people believe they might be lesbian or gay and seek out a community.
Identity acceptance — people identify as lesbian or gay and share this with some significant others.
Identity pride — people further disclose their identity, embrace this new identity and immerse themselves in the gay or lesbian communities and culture.
Identity synthesis — people fully integrate their identity into a larger picture of themselves, and their sexual orientation is no longer an issue.

The coming-out processes for bisexual people are distinct, yet there may be some similarities with Cass’s stage model.

Another model, by Devor (1997), consists of 14 identity development stages for female-to-male transsexuals:

Abiding anxiety — unfocused gender and sex discomfort.
Identity confusion — first doubts about suitability of assigned gender and sex.
Identity comparison — seeking and weighing alternative female identities.
Discovery — learning that female-to-male transsexualism exists.
Identity confusion — first doubts about the authenticity of own transsexualism.
Identity comparison — testing transsexual identity using transsexual reference group.
Identity tolerance — identity as probably transsexual.
Delay — waiting for changed circumstances; looking for confirmation of transsexual identity.
Identity acceptance — transsexual identity established.
Delay — transsexual identity deepens; no longer identify as women and females.
Transition — Changing genders, between sexes.
Identity acceptance — identities established as transsexual men.
Integration — transsexuality most visible.
Identity pride — publicly transsexual.

Additional probes

Whom did you tell? How did they handle it?

Did you go to bars when you came out?

Are there areas in your life where you feel you are not out?

Did you find that you used more alcohol or other drugs, or that your mental health was affected, during the coming-out/transitioning process?

Client perceptions

“When I came out, I actually stopped using drugs. I’m still going through the process.”

“Coming out is a profound psychological transformation. You’re basically redefining yourself in the eyes of everybody. It’s a very deep, very intimate thing. It’s tremendously important. It has to do with your self-perception as well as how other people see you.”

“I think it de-stressed me a whole lot. Coming out, you can be yourself. And when you are keeping that secret from people and you are all worried that someone is going to figure it out and they are not going to accept you, that just increases the depression, increases the dissociation, increases all this stuff. But when you start learning that people are not going to hate you, I think it makes your self-esteem go up. Most people with mental health issues have some sort of a low self-esteem thing going down. And when people start accepting you for who you are, I mean my self-esteem went up.”

“When, I came out, it was loud. It was a really scary time, so I took the fear like the bull by the horns and said, ‘Wow. It’s scary, so let’s just do it, really big, and then it will be over. I think I can muster some courage for a day, so let’s do it all today. Everyone at school will know and my dad will know. Everyone I know will know. And I’ll phone everyone I ever knew and tell them.’ So it was just, ‘Bang, here you go’ and not at all sensitive to anyone on the receiving end. And then I was very outward at school and the response was not good at all. I got a lot of graffiti on my locker. I had a couple of really close friends so that was okay in that way. I got beaten up once in my locker bay just at the end of school, and I stopped going to school at that point. I was fifteen and I never finished high school.”

Therapist/counsellor perceptions

“Secrecy if not out. It makes people not feel good about themselves. They use escapism, such as drinking or using drugs, to obliterate their sorrows.”

“Often clients come in here who are in the process of wondering whether they are going to come out as transmen, and grappling with that set of issues. Many, not all, but many, come from a lesbian background. And that experience of coming out as a lesbian and telling certain stories about oneself as a lesbian. And then for those who come out as trans, there is a kind of re-evaluation of all those narratives and a selection of other narratives.”

“When clients are trying to decide whether or not they’re coming out, there are certain things that you need to ask them to help them around. Do you feel safe? Who are you living with and is that stable? It might be safer for them to stay in the closet for the next year until they’re done college if they are getting full support from their parents. But, also looking at the other side, that the most unsafe for someone to be is in the closet, because their highest risk for suicide is while they’re in the closet. So, it’s that juggling act.”

“It never stops too. I mean, once you come out, you’re coming out the rest of your life.”

Coming out is the process by which LGBTTTIQ people acknowledge and disclose their sexual orientation or gender identity to themselves and others.

Transitioning is the process by which transsexual people change their appearance and body to match their internal (gender) identity, while living their lives full-time in their preferred gender role.

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Asking the Right Questions 2

Acknowledgments
Introduction
Using the manual
Background information:
- Part A — Client Questionnaire
- Part B — Conversation Guide
Counsellor competence
Resources
References
Appendix

ARQ2: Question B2 - Coming out and transitioning

Relevance/intent

Additional probes

Client perceptions

Therapist/counsellor perceptions

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