Feminist therapy theorists have made significant contributions to enhancing counselors' understanding of how social, economic, political, and institutional factors affect women's lives and the particular problems that women bring to counseling. Two of the central tenets of feminist therapy theory are the concept of an integrated analysis of oppression and the notion that the personal is political. The personal is political principle encourages counselors to attend to the external/sociocultural factors, such as heterosexism and sexism, that contribute to lesbians' psychological distress, as well as the ways that lesbian clients may have internalized negative and limiting heterosexist and sexist attitudes (Brown, 1994; Enns, 1997; Worell & Remer, 2003). The principle of an integrated analysis of oppression encourages counselors to help lesbian clients identify and explore how diverse sources of oppression in their lives interact and contribute to their current difficulties (Brown, 1994; Worell & Remer, 2003).
In support of feminist therapy theory, parallel bodies of research have suggested that experiences of heterosexist and sexist events are related to greater psychological distress for lesbian, gay, and bisexual (LGB) persons (e.g., Herek, Gillis, & Cogan, 1999; Waldo, 1999) and for women (e.g., Landrine, Klonoff, Gibbs, Manning, & Lund, 1995; Moradi & Subich, 2002), respectively. Yet, research on heterosexist events has given little attention to gender differences, and research on sexist events has generally ignored sexual orientation differences. Moreover, there is no research that examines the interactive effects of heterosexism and sexism on lesbian lives. Furthermore, parallel bodies of research suggest that internalized heterosexism in lesbians (e.g., Szymanski, Chung, & Balsam, 2001) and internalized sexism in women (e.g., Moradi & Subich, 2002) are related to greater psychosocial difficulties. Yet, this type of research on internalized sexism has failed to assess the influence of sexual orientation, and there is no research that examines the effects of both internalized heterosexism and internalized sexism on lesbians' mental health. Thus, little empirically based research has focused on the fact that lesbians may face oppression based on both their sexual orientation and their gender. The purpose of this study was to examine the complex roles of heterosexism and sexism within the lives of lesbians.
Heterosexism and Internalized Heterosexism
Research has indicated that many LGB persons have experienced heterosexist events, including prejudice, harassment, discrimination, and violence, and that these experiences are related to adverse psychological, health, and job-related outcomes (Herek et al., 1999; Lewis, Derlega, Berndt, Morris, & Rose, 2001; Mays & Cochran, 2001; Waldo, 1999). Moreover, Herek et al. found that LGB survivors of recent (within the past 5 years) sexual-orientation-based hate crimes manifested greater anger, anxiety, depression, and post-traumatic stress than did both LGB survivors of non-sexual-orientation-based crime victimization and LGB persons who had not experienced crime victimization.
In their review of the literature, Szymanski and Chung (2003b) reported that lesbian internalized heterosexism is correlated with a variety of negative mental health outcomes, such as more depression, less social support, and higher levels of demoralization. Internalized heterosexism was also found to be related to greater psychological distress; however, the sample was limited to 57 lesbians treated for early stage breast cancer (McGregor et al., 2001). Thus, research using larger and more diverse samples to examine the relationship between internalized heterosexism and psychological distress is warranted.
Two studies have examined both heterosexism and internalized heterosexism concurrently. Meyer's (1995) study, which focused solely on gay men, found that the experience of anti-gay discrimination and/or violence within the past year, internalized heterosexism, and perceived stigma associated with being gay were related to more psychological distress. …