Navigating Sexual Identity And Same-Sex Attraction In Therapy With Teens

Does Sexual Orientation Matter In Therapy For Teens? Yes and No.

Teens who are exploring same-sex attraction or identifying as gay, lesbian, bisexual, or queer need what all teens need in therapy regardless of their orientation. They need help making sense of relationships, understanding what turns them on and navigating what sort of sex feels safe, fun and that they’re mature enough to take on. There’s also discrimination and bullying (both in-person and online), specific concerns about safe sex, especially for men who have sex with men, and sexual violence, which disproportionately affects gay and lesbian men and women.

In particular, lots of teens we see in our therapy practice have embraced a sort of post-identity attitude about sexual orientation. Their attitudes about themselves and their peers is that labels like gay, straight or bi aren’t so important. In some ways, this is a product of their having grown up in a world that is more embracing of different orientations. Part of the challenge, though, is that while teens and their peers may feel that way, it doesn’t mean that everyone in the world around them is as accepting.

A Quick Note On Our Use Of Queer

As therapists who work with patients of all ages with a range of sexual identities, we know there’s so much politics wrapped up in the word queer. But in most instances, we use it. Part of what we like about the word is that it’s a prime example of a word initially used to ridicule a group of people that has been well reclaimed. It also leaves room to mean a lot without imposing a particular, narrow meaning on an individual’s sexual orientation.

However, it may also be the case that a given individual who embraces or is questioning their sexual identity may not find the word meaningful and could be offended. In many ways, negotiating language is an important part of good therapy.

Queer Teens: Still In Harm's Way

Progress is a wonderful thing and NYC is an especially accepting place. At the same time, national figures and politicians still freely express hateful rhetoric toward the queer community and violence against queer-presenting individuals, including teenagers, is very much a reality even for teens in New York. According to the Trevor Project, lesbian, gay, bi or queer teens contemplate suicide at three times the rate of non-lesbian, gay, bi or queer teens. The CDC reports that men who have sex with men account for most of the new and existing HIV infections among men. It should be noted that race and class can also affect a teen’s experience of the gains made, as well as their risk in regards to sexual violence, suicidality or hate crimes.

We hear from parents all the time how surprised they are at how open and confident teenagers seem to be around sexuality and same-sex attraction. But that doesn’t mean queer or questioning teens don’t need help and don’t (or won’t) experience discrimination. As parents, therapists and other adults in teens’ lives, this means we may need to look a bit harder and differently at what teens need to be safe in the world.

Is Sexual Orientation A Choice?

Human rights advocates, who spent decades fighting for the recognition of homosexuals as human beings worth protecting and worthy of a right to express themselves openly, largely rallied around an argument that sexual preference wasn’t a preference at all. Instead, they insisted it was an orientation–one that was biologically fixed or, at least, predisposed. They backed this up with both anecdotal narratives of sexual discovery and modest scientific claims about the biological origins of sexual preferences.

While we have to appreciate the significance of that battle and while it’s likely the argument was integral to advances like the legalization of same-sex marriage, many young people find this argument–orientation vs. preference–to be a tired one. Why do I need to make the case, a queer teen might argue, that my sexual attraction isn’t a choice in order for it to be respected?

Teens May Be Ahead Of Their Parents In How They Think About Same-Sex Attraction: We Can Help

The good news for parents who find themselves confused about how teenagers talk about sexuality is that they don’t need to have a full understanding of the arguments or take a firm position. In our experience, parents we work with rarely have rigidly anti-gay attitudes about their teen’s sexual choices, but they may have ideas that are somewhat outmoded or they may have trouble understanding their teen’s views on sexual orientation. Often it seems like teens are ahead of their parents in how they conceive of same-sex attraction and sexual identities.

What’s needed, as with all meaningful questions with teenagers, is that parents be present, be curious and be open to discovering what their teens are still discovering. Part of our challenge, as therapists who work with teens, is helping parents who are reasonably progressive recognize that they still have things to learn from and about their teen.

Teens Often Reject Labels, Which Doesn’t Mean They Aren’t Struggling With Understanding Who They Are

Parents are often surprised to learn that the hard-fought battles around identity and sexual orientation that they witnessed and participated in aren’t so relevant to the politics of their teenage children. Teens often eschew labels, appreciating that sexual attraction can be fluid and doesn’t need to be defined.

Part of what follows from this is the very thing that’s being given attention is hard to name. What’s important from our point of view as therapists who work with teens is that the need for help not get lost in the confusion over labels. If a teen says, “Hey, I don’t need to define things,” parents may need help not getting stuck with this. We help parents recognize that just because a teen doesn’t define themselves as gay or bi doesn’t mean they aren’t stuck or struggling with understanding who they are or navigating what it means for them to be in the world.

The conversation, then, is less about, “How do we, as therapists, help you thrive in the world as a gay teen?” Rather, we ask, “How do we help you thrive in the world as who you are, including your sexuality (while you’re figuring it out), and with an understanding that the world may still have a hard time with some of the ways you express yourself?”

Teens And Bisexuality

There’s a long history of skepticism and even animosity toward the notion of bisexuality from both within and without the gay community. Some see, for example, individuals, who consider themselves bisexual, to be truly gay, but wanting to avoid some of the consequences of that identity. Similarly, teens who identify as bisexual but date someone of the opposite sex can sometimes be given a surprisingly hard time from friends or peers who date same-sex partners.

We support teens (and encourage parents to support teens) not to close themselves off from ways of expressing sexuality and to honor their choices about how they define themselves, even if those definitions aren’t simple or familiar. In many cases, we’re happy to offer teens the idea that they don’t have to choose and don’t have to put themselves in a box. In other cases, having a label can bring a sense of fraternity with others who see themselves similarly. Ultimately, it’s up to the teen. Our job, as therapists and parents, isn’t to impose our understanding, but to listen and offer guidance in helping teens make sense of who they want to be in the world.

What About Teens Who Are Questioning Their Sexuality?

Most teenagers are questioning something related to sexuality and same-sex attraction is part of that. Am I gay? Am I bi? Does it matter? In a post-essentialist world where teens are less likely to believe in sexual orientation as a fixed state, the answers can seem, well, fluid.

As with all therapy with teens, being reasonably tuned into the realities of what teens are dealing with while resisting the temptation to make assumptions based on those realities is the key to helping teens find their way through. In our therapy practice, we also work to help teens’ parents make sense of how to support and be close to their teen as they figure this out.

Do Queer Or Questioning Teens Need A Queer Therapist?

Maybe yes, maybe no. Teens who are gay, lesbian, bisexual, queer or questioning certainly need a therapist who is accepting, understands some of the issues teens are dealing with and is with the times about these issues no matter what the therapist’s orientation. Queer teens also need queer peers and adults in their lives. For teens that don’t have this community, having a therapist who identifies as queer may be a way to connect and help with that.