Case Study: Treatment of Homophobia in a Gay Male Adolescent

By Lock, James | American Journal of Psychotherapy, Spring 1998 | Go to article overview

Case Study: Treatment of Homophobia in a Gay Male Adolescent


Lock, James, American Journal of Psychotherapy


This paper presents an extended discussion of the treatment of an adolescent male for internalized homophobia. It discusses a case that illustrates the problems and stages that gay adolescents go through as they move through different phases of adolescence.

BACKGROUND For adolescents who are gay or lesbian, significant problems can develop secondary to internalized homophobia-the self-hatred that occurs as a result of being a socially stigmatized person. In one recent study of this group (ages 15-21), it was found that as a result of their sexual orientation 80% had experienced verbal insults, 44% had been threatened with violence, 33 % had objects thrown at them, 31% reported being chased or followed, and 17 % reported being physically assaulted.l Numerous studies have identified an increased suicide-attempt rate among gay and lesbian youth.2 Other studies find increased high school dropout rates, substance abuse, and family discord in families with gay youth and adolescents.3

In order to assist gay and lesbian youth with homophobia, therapists employ both individual and group approaches.4 Key elements of psychodynamic treatments include efforts to neutralize internalized homophobia through education, interpretation of anxieties about passivity, dependency, and masculinity and femininity, and supportive and homosexual identityaffirming techniques.5 Group approaches for teens and young adults aim to diminish isolation, create supportive communities, and serve as psychoeducational forums.67 Other treatments focus on the societal origins of homophobia and have attempted to provide prevention and intervention for gay and lesbian youth in high schools or community centers.8

The following case illustrates the impact of homophobia on the development of a gay teenager as he moves through early, middle, and late adolescence. CASE J.,a 14-year-old student between his freshman and sophomore year of high school, was referred to me by a child psychiatrist who had seen J. and his family for an evaluation after J. had abruptly returned home from boarding school. In his referring call, the psychiatrist said that J. wished to have support for developmental issues associated with being a gay teenager. The psychiatrist felt he did not have the skills to provide optimal treatment. J.'s mother called to make the initial appointment for J. She described her son as very bright and strong willed. She was supportive of him in trying to get help from me.

J. had entered his freshman year at a prominent preparatory school, leaving his family for the first time the preceding fall. He did fairly well at first, but became increasing despondent as the fall semester progressed. He began to call home almost daily and sometimes more than once a day, begging to come back home. He offered no explanation for this request to return except that he missed his family. He returned and enrolled in a local school. According to his mother, J. became moody, withdrawn, extremely hostile and alternatively very needy after his return. Although she was concerned, it was not until he told his family that he was gay that they understood the cause of his behavior. However, his disclosure resulted in J. wishing to run away or commit suicide. He reported feelings of isolation and anger, and considered his family a "barrier" for him to develop other social or emotional supports. He reported sleep problems and feelings of sadness, but no problems with appetite or concentration.

J. was the oldest of three children in an intact family. He had two sisters who were younger than he. J.'s mother was a librarian and his father a business manager. There were no financial problems in the family. J. was described as a child with a difficult temperament who could also be demanding and willful. He had been a physically uncoordinated child from his earliest years.

His parents, especially his mother, doted on him and clearly had difficulty,limiting him. …

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