Goldfried, M. R., & D'Zurilla, T. J. (1969).
A behavioral-
Selected Bibliography
D'Zurilla, T. J., & Goldfried, M. R. (1971). Problem
solving and behavior modification. Journal of Abnormal
Psychology, 78, 107-126.
Goldfried, M. R. (1971). Systematic desensitization as
training in self-control. Journal of Consulting and Clinical
Psychology, 37, 228-234.
Goldfried, M. R. (1980a). Psychotherapy as coping skills
training. In M. J. Mahoney (Ed.), Psychotherapy process:
Current issues and future directions (pp. 89-119). New
York: Plenum.
Goldfried, M. R. (1980b). Toward the delineation of
therapeutic change principles. American Psychologist, 35,
991-999.
Goldfried, M. R. (Ed.). (1982). Converging themes in
psychotherapy: Trends in psychodynamic, humanistic, and
behavioral practice. New York: Springer.
Goldfried, M. R. (1995). From cognitive-behavior therapy
to psychotherapy integration: An evolving view. New York:
Springer.
Goldfried, M. R. (1999). Reflections of a
scientist-practitioner. In S. Soldz & L. McCullough (Eds.),
Reconciling empirical knowledge and clinical experience:
The art and science of psychotherapy (pp. 17-32).
Washington, DC: American Psychological Association.
Goldfried, M. R. (2000). Consensus in psychotherapy
research and practice: Where have all the findings gone?
Psychotherapy Research, 10, 1-16.
Goldfried, M. R. (Ed.). (2001). How therapists change:
Personal and professional reflections. Washington, DC;
American Psychological Association.
Goldfried, M. R., Castonguay, L. G., Hayes, A. H., Drozd,
j . F., & Shapiro, D. A. (1997). A comparative analysis of
the therapeutic focus in cognitive-behavioral and
psychodynamic-interpersonal sessions. Journal of
Consulting and Clinical Psychology, 65, 740-748.
Goldfried, M. R., & Davison, G. C. (1976). Clinical
behavior therapy. New York: Holt, Rinehart & Winston.
Goldfried. M. R., & Davison, G. C. (1994). Clinical
behavior therapy (expanded ed.). New York:
Wiley-Interscience.
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analytic model for assessing competence. In C. D.
Spielberger (Ed.), Current topics in clinical and community
psychology (Vol. 1, pp. 151-196). New York: Academic
Press.
Goldfried, M. R, & Goldfried, A. P. (2001). The
importance of parental support in the lives of gay, lesbian,
and bisexual individuals. Journal of Clinical Psychology/In
Session: Psychotherapy in Practice, 57, 681-693.
Goldfried, M. R., Raue, P. J., & Castonguay, L. G. (1998).
The therapeutic focus in significant sessions of master
therapists: A comparison of cognitive-behavioral and
psychodynamic-interpersonal interventions. Journal of
Consulting and Clinical Psychology, 66, 803-810.
Goldfried, M. R., & Wolfe, B. E. (1996). Psychotherapy
practice and research: Repairing a strained alliance.
American Psychologist, 51, 1007-1016.
Goldfried, M. R, & Wolfe, B. E. (1998). Toward a more
clinically valid approach to therapy research. Journal of
Consulting and Clinical Psychology, 66, 143-150.
Norcross, J. C , & Goldfried, M. R. (Eds.). (1992).
Handbook of psychotherapy integration. New York: Basic
Books.
Samoilov, A., & Goldfried, M. R. (2000). Role of emotion
in cognitive-behavior therapy. Clinical Psychology:
Science and Practice, 7, 373-385.
Wolfe, B. E., & Goldfried, M. R. (1988). Research on
psychotherapy integration: Recommendations and
conclusions from an NIMH workshop. Journal of
Consulting and Clinical Psychology, 56, 448-451.
Integrating Gay, Lesbian, and Bisexual Issues
Into Mainstream Psychology
Marvin R. Goldfried
Stale University of New York at Stony Brook
Despite the growing clinical and research literature
dealing with gay, lesbian, and bisexual (GLB) issues,
mainstream psychology has tended to ignore much of
the work that has been done in this area. This article
illustrates how clinical and research writings on GLB
issues continue to remain invisible to mainstream psy-
977
 chology in such areas as life span development and
aging, teenage suicide, substance abuse, victimization
and abuse, and family and couple relationships. It also
deals with some of the determinants of well-being
among GLB individuals, such as family support, and
notes the benefits accruing to mainstream psychology
from studying GLB issues. A network of family mem-
bers within psychology having GLB relatives has been
formed—AFFIRM: Psychologist Affirming Their Gay,
Lesbian, and Bisexual Family—and is dedicated to
supporting its own family members, encouraging other
family members to do likewise, supporting research
and clinical work on GLB issues, and closing the gap
between GLB clinical and research work and main-
stream psychology.
For most of my career, my primary clinical and research
interests have centered around clinical assessment and
psychotherapy, particularly in the areas of behavior ther-
apy and psychotherapy integration. However, this is about
to change. After many years of silence, I have decided it
is time for me to come out professionally—not as a gay
man but as the father of a gay son. As a result, I am be-
ginning to devote more of my professional energies to
research and clinical work on gay, lesbian, and bisexual
(GLB) issues.
There have been two experiences that have led me to
this decision. The first involved my participation in a gay
pride parade several years ago, and the second occurred
at a symposium at an Association for the Advancement of
Behavior Therapy (AABT) conference. In attending the
gay pride parade, my wife and I decided to march with
the Parents, Family, and Friends of Lesbians and Gays
(PFLAG) contingent. In doing so, we had the opportunity
to witness the profound loss of family support that many
gay men, lesbians, and bisexuals have suffered. The on-
lookers had very definite emotional reactions as we
passed by with our banners reading "We love our gay
and lesbian children" and "You will always have a home
in PFLAG." They responded with shouts of "We love
you, too" and "We wish our parents would march." The
verbal responses and facial expressions of the younger
Editor's Note
Marvin R. Goldfried received the Award for Distin-
guished Professional Contributions to Knowledge. Award
winners are invited to deliver an award address at APA 's
annual convention. This award address was delivered at
the 109th annual meeting, held August 24-28, 2001, in
San Francisco. Articles based on award addresses are
not peer reviewed, as they are the expression of the win-
ners' reflections on the occasion of receiving an award.
978
onlookers communicated happiness and longing; the older
women and men were silent, looking sad and regretful,
perhaps reflecting a never-to-be-fulfilled longing. This
experience provided me with the profound realization of
how important family support—or lack thereof—is in the
lives of GLB individuals.
The second experience was at a very crowded AABT
symposium dealing with the appropriateness of altering a
GLB person's sexual behavior and orientation. One of the
panelists was a colleague with whose opinion I disagreed
somewhat. However, I knew that my view was likely to
be controversial and might be perceived by some as being
antigay. I felt the need to raise my point from the audi-
ence but was concerned about a possible negative reac-
tion on the part of others in the room. Consequently, I
prefaced my comment by stating that one of my two fa-
vorite sons was gay and that I was a dues-paying member
of PFLAG. When the meeting was over, the colleague
approached me and indicated that it was brave of me to
say what I had said. At first, I thought he was referring to
my contrary opinion, but he quickly indicated that he was
referring to my self-disclosure—noting that I had come
out.
I would like to begin by commenting on the impor-
tance of family support in the lives of GLB individuals. I
then offer an overview of how the mental health profes-
sions have conceptualized homosexuality over the years.
Next, I document how the mainstream professional litera-
ture has ignored GLB issues, with the unfortunate conse-
quences that have resulted from this. Some of the deter-
minants of psychological well-being among GLB
individuals are considered, as well as the benefits accru-
ing to mainstream psychology from studying GLB issues.
I conclude by describing the formation of a network of
mainstream psychologists who represent family of GLB
individuals and how it can help to close this gap between
the mainstream and GLB literature.
The Importance of Family Support
There is no question but that the status of GLB individu-
als has improved dramatically in very recent years. None-
theless, they continue to represent a stigmatized segment
of society both inside and outside the home, where they
continue to experience both verbal and physical abuse.
The reactions of family members to their GLB rela-
tives can serve to either exacerbate or alleviate distress.
In a study of victimized youth, Hershberger and
D'Augelli (1995) found that symptomatology was signifi-
cantly reduced as a function of parental support. It was
also found by Savin-Williams (1989) that self-esteem
among lesbians was positively correlated with a satisfac-
tory relationship with their mothers and that self-esteem
in gay men was related to a positive relationship with
both mother and father.
November 2001 • American Psychologist
 When GLB individuals fear they cannot be open about
their sexual identity within the predominant heterosexual
social system, their only recourse is to hide (Martin, 1982).
Indeed, this theme of hiding has traditionally characterized
the lives of many GLB individuals. It has only been in
very recent years that there has existed greater support for
GLB youth to come out earlier in life, resulting in the de-
velopment of a more positive, self-accepting identity
(Savin-Williams, 1998, 2001b). This change in societal
attitudes clearly underscores the cultural relativity associ-
ated with the acceptability of being gay. As is well known,
there was a far more accepting view of male same-sex be-
havior in ancient Greek and Roman societies. In some Na-
tive American cultures, there is a positive quality associ-
ated with so-called "two-spirited people." And, some years
ago, it was Woody Allen who pointed out that one of the
advantages of being bisexual is that it doubles your
chances of getting a date on New Year's Eve!
Of course, not everybody sees it that way. When parents
learn that their daughter or son is gay, the initial reactions
are often negative. The adjustment on the part of some par-
ents, as well as perhaps their eventual acceptance of this
reality, has been likened to a grieving process. Dealing
with this reality is very much a process and, as such, takes
time and corrective experiences. Many of these experiences
can be facilitated by having contact with other supportive
parents, often through PFLAG. PFLAG is an organization
that is designed to support family members who have
learned that their son, daughter, or other family member is
GLB. Its mission is also to educate the public and to advo-
cate for equal rights for lesbian, gay, bisexual, and trans-
gendered individuals. Although there are no data to support
this, I believe that PFLAG, rather than individual or family
therapy, is the intervention of choice to help facilitate pa-
rental acceptance of GLB children.
Not too long ago, I attended a local PFLAG support
group at which a very angry and distressed mother reported
that her son had just come out to her. Even at the coffee
hour before the actual group began, she had difficulty in
containing herself. She indeed was in the midst of a crisis.
She began the group discussion by tearfully expressing her
anger on hearing the news that her son was gay, question-
ing, "How could he do this to me?" and "Doesn't he know
he's ruining my life?" Approximately halfway into the
meeting, after she had the opportunity to describe what had
happened and how she felt, a young woman in her early
twenties described her own current dilemma. Although she
had come out to some of her friends, she had not done so
to her mother and father. With great anguish, she described
her fears associated with her parents learning that she was
a lesbian. She was struggling with the choice of openly
being who she was but fearful of the possibility of being
disowned by her parents, whom she loved dearly. As she
spoke to the others in the room and received support from
November 2001 • American Psychologist
the group—consisting mostly of parents—I watched the
expression on the face of the mother who had spoken ear-
lier. She appeared stunned in hearing what it was like from
the child's point of view, and her face softened to reveal
the sadness and sympathy she felt for this young woman.
This experience, as well as others I have witnessed, is what
leads me to conclude that referral to PFLAG should be the
intervention of choice in fostering parental acceptance.
The Conception of Homosexuality Within Mental
Health Professions
Over the years, the mental health professions have evolved
considerably in how they deal with the topic of homosexu-
ality. For example, the 1955 Group for the Advancement
of Psychiatry report on the sexual orientation reflected the
prevailing theme of the time, identifying homosexuality as
a form of sexual perversion . . . psychological in origin [with]
no valid evidence that homosexuality is inherited. Homosexu-
ality is an arrest at, or a regression to, an immature level of
psychosexual development. While the treatment of homosexu-
ality is difficult and time-consuming, success has been re-
ported. Psychotherapy offers the best chance of success, par-
ticularly in the turbulent transition period from adolescence to
maturity wherein sexual goals have not been finally estab-
lished. (Group for the Advancement of Psychiatry, 1955, p. 6)
During that time period, there were also, in such places as
psychoanalytic institutes, discriminatory policies that main-
tained that gay and lesbian candidates were unfit for train-
ing. It should come as little surprise that therapists who
themselves were homosexual remained closeted.
The evolution of this antigay bias within the field is
reflected in the changes in the Diagnostic and Statistical
Manual of Mental Disorders (DSM) over the years. In
the first edition appearing in 1952 (American Psychiatric
Association, 1952), homosexuality was categorized as a
"sociopathic personality disorder." In the 1968 revision
(American Psychiatric Association, 1968), it was reclassi-
fied as a "sexual deviation." The version of DSM appearing
in 1980 (American Psychiatric Association, 1980)—DSM-
III—limited the category only to individuals who were dis-
tressed about their homosexuality, creating the classifica-
tion of "ego-dystonic homosexuality." The version that
appeared seven years later as DSM-III-R (American Psy-
chiatric Association, 1987) removed homosexuality as a
diagnostic category altogether.
In his presidential address delivered at the 1974 AABT
meeting, Davison (1976) strongly condemned the practice
of conversion/reparative therapy, urging his fellow behav-
ior therapists to question the moral and ethical implications
of attempting to alter an individual's sexual behavior and
orientation. Within psychoanalytic circles, it was not until
the 1990s that gay and lesbian therapists began to openly
criticize the existing conceptual models of homosexuality.
979
 Much like what had happened when women entered the
profession and began to challenge gender biases in the
field, GLB analysts began to question existing conceptual-
izations of homosexuality. The difference is that GLB ana-
lysts had always been there but were only now able to
speak out—at the risk of stigmatization.
It may be argued that this antihomosexual bias is rooted
in psychoanalytic theory. To some extent, it is. However,
one cannot totally blame theory for psychologists' antigay
bias. In a survey of behavior therapists by Davison and
Wilson (1973), it was found that although the respondents
indicated that they would not attempt to change the sexual
orientation of homosexual clients who did not wish to
change and that they did not view homosexuality as being
pathological, they nonetheless had conceptions of it as be-
ing less good, less masculine, and less rational than
heterosexuality.
In 1975, the American Psychological Association (APA)
adopted a clear position against homosexual bias, and psy-
chologists were encouraged to work toward removing this
long-standing stigma. Five years later, APA instituted the
standing Committee on Lesbian and Gay Concerns. In
1991, the committee reported the results of a survey of
what psychologists knew about the experiences of lesbians
and gay men with psychotherapy. It found that 84% of the
respondents knew of cases in which lesbians or gay men
were adversely affected by their therapeutic experiences
(Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991).
Analogue psychotherapy research by Gelso and his col-
leagues (Gelso, Fassinger, Gomez, & Latts, 1995; Hayes &
Gelso, 1993) involving videotaped clients demonstrated
that both male and female therapists were less cognitively
attuned to lesbian clients than to heterosexual female cli-
ents and that male therapists' homophobia was associated
with less effective therapeutic interactions. Still another
example of bias within the field may be seen in a more
recent survey that revealed that practicing psychologists
were less likely to recommend adoption for a gay or les-
bian couple than they were for a heterosexual couple, and
that the belief that homosexuality was a matter of choice
was a significant variable associated with this decision
(Crawford, McLeod, Zamboni, & Jordon, 1999).
In an excellent chapter appearing in Perez, DeBord, and
Bieschke's (2000) Handbook of Counseling and Psycho-
therapy With Lesbian, Gay, and Bisexual Clients,
Bieschke, McClanahan, Tozer, Grzegorek, and Park's
(2000) review of the literature indicated that gay men and
lesbians are far more likely to make use of individual psy-
chotherapy than are heterosexuals. This is also true of les-
bian and gay couples in that approximately one half of les-
bian couples and close to one third of same-gender male
couples indicate that they have sought professional help for
relationship issues (R.-J. Green, 2000b). A survey of mem-
bers of the American Association for Marriage and Family
980
Therapy confirmed this, finding that the vast majority of
respondents (72%) reported that 1 out of 10 couples they
saw clinically involved same-gender relationships (S. K.
Green & Bobele, 1994). Unfortunately, in a separate sur-
vey of therapists within the same organization, it was
found that almost half indicated that they did not feel clini-
cally competent in working with gay men and lesbians
(Doherty & Simmons, 1996).
The more frequent use of therapy by GLB individuals
may be explained by the fact that they not only have to
deal with the kind of issues that confront heterosexual cli-
ents but also need to cope with stigmatization, family re-
jection, oppression, sexual identity issues, and internalized
societal homophobia (Bepko & Johnson, 2000; Liddle,
1997). In reporting on the results of the National Lesbian
Health Care Survey carried out in the mid-1980s, Bradford,
Ryan, and Rothblum (1994) described some of the distress-
ing life issues confronted by the participants. They found
that 37% had been physically abused and 32% had been
raped or sexually attacked. Close to one out of five experi-
enced incestuous relationships when growing up. One in
five at times thought about committing suicide, and close
to that number had actually made the attempt. More than
half reported that anxiety interfered with their functioning,
and over a third had been depressed. What is particularly
distressing about the findings is that the survey was based
primarily on well-educated professional women, describing
what the authors indicated as being the best scenario for
lesbians in the United States.
Although mental health professions no longer consider
homosexuality a disorder, there nonetheless has been a
movement to "cure" GLB individuals (Haldeman, 1999).
Alternately called conversion or reparative therapy, these
attempts seem to be religiously and politically motivated
and serve to reinforce the concept of homosexuality as a
mental illness. The effectiveness of these interventions is
controversial (Spitzer, 2001), and clinical contact with indi-
viduals who have gone through conversion or reparative
therapy suggests that some individuals are harmed by this
experience (Haldeman, 1999).
Several publications that provide useful information for
therapists who work clinically with GLB individuals have
recently been published (see, e.g., Campos & Goldfried,
2001; Greene & Croom, 2000; Perez et al., 2000). In Feb-
ruary 2000, the APA Council of Representatives adopted
Guidelines for Psychotherapy With Lesbian, Gay, and Bi-
sexual Clients, which were developed by a joint task force
comprised of members of Division 44 and the Committee
on Lesbian, Gay, and Bisexual Concerns. This document,
which was published later that year (Division 44/Commit-
tee on Lesbian, Gay, and Bisexual Concerns Joint Task
Force on Guidelines for Psychotherapy With Lesbian, Gay,
and Bisexual Clients, 2000), is designed to guide both
graduate students in training and practicing therapists in
November 2001 • American Psychologist
their clinical work with GLB clients. The guidelines review
a number of the issues associated with GLB individuals
(e.g., the risks that exist for adolescents, life challenges,
stigmatization, family issues), the implicit biases that may
exist among practicing therapists, and the need for psychol-
ogists to become better aware of these issues if they are to
work with GLB individuals—which they are clearly likely
to do.
The Gap Between Mainstream and GLB Literature
As indicated earlier, a long-standing theme in the lives of
GLB individuals has been the need to be in hiding—to be
invisible. This has also characterized the mental health pro-
fessions over the years, in that GLB professionals have
remained closeted. Not surprisingly, the mainstream litera-
ture has had a history of having little of a positive nature
to say about GLB issues. It was as if the implicit guideline
between GLB and mainstream professionals was "Don't
tell/don't ask." Since the Stonewall rebellion over 30 years
ago, which marked the beginning of a very dramatic gay
rights movement, GLB individuals have been able to be
more open about who they are. This trend has also been
seen within the mental health professions, in that there has
been a marked increase in professional writings about GLB
issues, typically by people who have decided to come out
professionally. Although the mental health professions have
shown support for GLB concerns, the GLB literature con-
tinues to remain invisible to those outside the area and has
not been incorporated into the mainstream body of knowl-
edge. It appears that GLB professionals are now telling,
but the rest of psychology has not been listening.
I would hasten to add that I am as guilty of this as any-
one. Even though I strongly suspected that my son was gay
over 20 years ago and have known for certain for more
than 10 years now, I typically ignored the GLB literature.
One may speculate about the various reasons why this may
have occurred for myself and for others, including the fact
that there has always been—and still is—a stigma associ-
ated with writing about GLB issues (Rothblum, 1995). Of
course, it is possible to argue that much of what is written
about in this area is not relevant to one's research and clin-
ical interests. I would like to illustrate, however, how this
is not at all the case.
There are many issues in the GLB literature that, al-
though having a direct bearing on issues currently receiv-
ing attention within mainstream psychology, continue to
remain invisible. I comment on just a few of these, includ-
ing life span development and aging, teenage suicide, sub-
stance abuse, victimization and abuse, and family and cou-
ple relationships.
life Span Development and Aging
There is an extensive literature dealing with the develop-
mental milestones of GLB individuals (see, e.g., Cohen &
November 2001 • American Psychologist
Savin-Williams, 1996; Hershberger & D'Augelli, 2000;
Savin-Williams, 1998). For example, much has been writ-
ten about the developmental task of forming one's identity
during adolescence, where many of the same issues that
exist with heterosexual teenagers are relevant, along with
those uniquely associated with one's homosexual identity.
It is well known that negative self-concept is associated
with a host of psychological difficulties, including depres-
sion, anxiety, and level of functioning. This is very much
the case with GLB individuals, as demonstrated by a dra-
matic -.87 correlation that has been found between per-
sonal self-acceptance on the part of gay youth and the
existence of psychological problems (Hershberger &
D'Augelli, 1995). However, there is a long history within
the gay community of having individuals describe them-
selves with the term self-loathing, clearly reflecting the
messages gay youth are exposed to very early in life. Even
before they develop their own sexual identity, many boys
and girls have traditionally assimilated the view that there
is something very wrong with homosexuality. The openly
gay comic and author David Sedaris (1997), in providing a
poignant side to an otherwise funny story about his school
experiences, put it this way:
We had long ago identified one another and understood that
because of everything we had in common, we could never be
friends. To socialize would have drawn too much attention to
ourselves. We were members of a secret society founded on
self-loathing. When a teacher or classmate made fun of a real
homosexual, I made certain my laugh was louder than any-
body else's, (p. 85)
This internalization of the societal stigma comes at a
crucial developmental phase in the lives of GLB youth. As
observed by Cohen and Savin-Williams (1996), "At a time
when most youths are gradually building self-esteem and
establishing an identity, some sexual minority adolescents
are learning from peers and adults that they are amongst
the most hated in society" (p. 124).
The complex and difficult developmental task for GLB
youth is to form a positive identity for themselves when
many of the societal messages are negative. There is
clearly a cohort effect here, as GLB teenagers are now
growing up in a very different environment than those who
came to maturity a mere 10 to 20 years earlier (Savin-Wil-
liams, 1998, 2001b). Although GLB adolescents feel freer
about coming out, many nonetheless continue to face for-
midable stressors in doing so, such as being rejected or
even thrown out of the home by their parents.
Despite the available literature on developmental issues
among GLB youth, this is often ignored within mainstream
psychology. For example, nowhere in the fourth edition of
Sebald's (1992) text on adolescent development is there
any mention of GLB youth. Although a variety of ethnic,
racial, socioeconomic, and cultural factors are considered
981
in McLoyd and Steinberg's (1998) volume on minority
adolescents, nothing is said about sexual minorities. And in
an edited volume dealing with the impact of social change
on adolescent development (Crockett & Silbereisen, 2000),
none of the contributors make any reference to GLB
issues.
Another invisible aspect of GLB life span development
that has relevance to mainstream literature is the topic of
aging. With the graying of the U.S. population in general,
aging has been an area that has been receiving an increas-
ing amount of attention within psychology. Here, too, GLB
individuals not only need to deal with many of those same
issues confronting heterosexual individuals but also have
unique challenges. Much has been written about these chal-
lenges, dealing with such topics as the decline in physical
attractiveness, the relative absence of supportive family
members, health care concerns, the untimely death of part-
ners and friends, employment discrimination, and both le-
gal and financial limitations associated with same-sex part-
nerships (Baron & Cramer, 2000; Grossman, D'Augelli, &
O'Connell, in press). These challenges, together with the
emotional stress they bring, are clearly described in the
GLB literature but absent within mainstream psychology.
Teenage Suicide
Gay and lesbian youth are far more likely to attempt sui-
cide then are their heterosexual peers; estimates have been
made that approximately one out of three GLB youth has
attempted suicide (D'Augelli, Hershberger, & Pilkington,
in press; Hershberger & D'Augelli, 2000; Remafedi, Far-
row, & Deisher, 1991; Safren & Heimberg, 1999). In a
study by Safren and Heimberg (1999), GLB and heterosex-
ual youth were compared on the basis of suicidality and
other psychosocial variables. Consistent with past research,
Safren and Heimberg found that approximately one third of
the GLB participants reported having made a past suicide
attempt, in comparison with only 13% of their heterosexual
counterparts. However, after taking into account other rele-
vant variables—depression, hopelessness, substance abuse,
social support, stress, and coping—sexual orientation no
longer differentiated the two groups on suicidality. Thus, it
is not being GLB per se that puts an adolescent at greater
risk for suicide but rather other variables associated with
psychological distress. For example, it has been estimated
that close to one out of every five homeless youth in Los
Angeles, California, is GLB (Unger, Kipke, Simon, Mont-
gomery, & Johnson, 1997) and that the attempted suicide
rate among these gay-identified street youth exceeds 50%
(Kruks, 1991).
A reality that is also distressing is that the mainstream
literature on suicide all too often fails to mention the find-
ings obtained with GLB youth. For example, a brochure
published by the Association for the Advancement of Be-
havior Therapy (1992) on the topic of teenage suicide erro-
982
neously indicated that "There is no one, typical adolescent
suicide." As one researcher (Tremblay, 1995) questioned at
thie Sixth Annual Conference of the Canadian Association
for Suicide Prevention,
Why have most studies of youth suicide problems not been
concerned with identifying sexual orientation, and child sex-
ual abuse in their research? Is this how truly scientific work
should be done? . . . Has it been ethical, given the facts of the
case, for suicidologists to have ignored GLB issues? Why did
this happen?
In attending a conference on adolescent suicide two
years later, Mallon (1997) was similarly shocked to learn
that none of the experts who presented their work made
any mention of GLB adolescent suicide. One presenter,
during the course of her talk, raised the question, "What
secret could be so terrible that you would rather kill your-
self then tell?" As neither the presenter nor any member of
the audience provided an answer, Mallon approached her
afterwards and asked why she had not mentioned the
higher risk of suicide among lesbian and gay adolescents.
Her response was, "Oh, I never even thought about them."
(Mallon, 1997, p. 25).
Substance Abuse
It has been found that GLB adolescents and adults have
higher frequencies of substance abuse (see, e.g., Hersh-
berger & D'Augelli, 2000). It is also generally known that
individuals are at a higher risk for suicide if they abuse
alcohol and drugs—in the population at large and also
within the GLB community. Compared with those GLB
individuals who do not attempt suicide, four times as many
young gay and bisexual individuals who make suicide at-
tempts have a past history of treatment for chemical depen-
dency (Hershberger & D'Augelli, 2000).
Within the mainstream literature, much has been written
about adolescent substance abuse. For example, in an arti-
cle entitled "A Comprehensive and Comparative Re-
view of Adolescent Substance Abuse Treatment Outcome,"
appearing in a recent issue of Clinical Psychology: Science
and Practice, Williams and Chang (2000) reviewed the
results of 53 studies carried out on this topic. The client
characteristics reported in these studies include race/ethnic-
ity, gender, socioeconomic status, past arrests, suicide at-
tempts, school problems, and family conflict. Nowhere is
sexual orientation mentioned, which is obviously not the
fault of the authors but rather a reflection of the nature of
mainstream research carried out on this topic (see Herek,
Kimmel, Amaro, & Melton, 1991; Rothblum, 1994).
Another study appearing that year (Kilpatrick et al.,
2000), entitled "Risk Factors for Adolescent Substance
Abuse and Dependence: Data From a National Sample,"
reported on the findings of a national survey of over 4,000
adolescents between the ages of 12 and 17. In this report,
November 2001 • American Psychologist
the authors indicated that they controlled for those demo-
graphic factors that were believed to increase the risk of
substance abuse, including age, race, gender, and parental
substance use. One of the findings that resulted from those
surveyed was that adolescents who had been physically or
sexually abused had an increased risk for substance abuse
and dependence. Nowhere in this report is there in any
mention of sexual orientation.
Victimization and Abuse
It is estimated that 1 out of every 3 gay youth is verbally
abused by family members, 1 out of 10 is physically as-
saulted by a family member, and 1 out of 4 has experi-
enced physical abuse at school (Hershberger & D'Augelli,
2000). It has also been found within a GLB population that
there is a positive association between early abuse and cur-
rent depression, suicidality, and risky sexual behavior.
Reporting on the results of the National Lesbian Health
Care Survey, Descamps, Rothblum, Bradford, and Ryan (in
press) indicated that lesbians who had a history of early
sexual abuse and more recent partner violence reported
higher levels of stress, depression, and alcohol abuse.
Moreover, lesbians who were victims of physical hate
crimes had significantly more stress and drug abuse than
those whose physical assault was not associated with a hate
crime. Although Descamps et al. found that early abuse
was no more prevalent among lesbians than heterosexual
women, Brown (1995) has pointed out that because they
are made up of two women, lesbian couples are more
likely to include at least one person who was the victim of
early physical or sexual abuse.
Partner abuse is common in same-gender male and fe-
male relationships, with some estimates being close to 50%
(West, 1998). However, because most people typically
think of partner abuse as involving male violence against
women, same-gender abuse is often ignored in mainstream
circles (Renzetti, 1994; Renzetti & Miley, 1996). Same-
gender abuse is also likely to be less visible in that there is
often a reluctance to let others know about it, either be-
cause one or both members of the couple may not be fully
out or because of a very real fear of discrimination by the
police.
The mainstream literature on physical and sexual abuse
in children, victimization, and posttraumatic stress disorder
has dealt with numerous issues associated with assessment
and intervention. To my knowledge, little if anything has
been said in this literature about these related issues within
a GLB population.
Family and Couple Relationships
Despite accusations within some quarters that GLB indi-
viduals are antifamily, the reality is that families play a
most important role in their lives. A frequently asked ques-
tion within GLB circles is, "Have you come out to your
November 2001 • American Psychologist
family?" If answered in the affirmative, the next question
usually is, "How did they take it?" As indicated earlier,
parents and other family members often react negatively on
hearing the news (D'Augelli, Hershberger, & Pilkington,
1998). Having a GLB family member clearly changes the
nature of the family dynamics, and GLB individuals often
find themselves needing to create new "families" out of
their friends to substitute for their family of origin.
The discussion of such issues is virtually invisible in the
mainstream family literature (Crosbie-Burnett, Foster, Mur-
ray, & Bowen, 1996). In a review of 718 articles submitted
for publication in the Journal of Marital & Family Ther-
apy between the years 1990 to 1995, only 7 dealt with
GLB issues (R.-J. Green, 2000b). An even more compre-
hensive survey of 17 journals during the 20 years from
1975 to 1995 revealed that only a little more than half of
one percent focused on family issues associated with GLB
individuals (Clark & Serovich, 1997).
There are instances where the failure to acknowledge
relevant GLB issues within the mainstream family litera-
ture can be harmful. R.-J. Green (2000a) pointed to this in
a critique of an article that recommended the importance of
coming out to one's parents as a psychologically healthy
move in differentiating oneself from one's family. What
that article failed to note was the finding that some GLB
individuals can suffer negative consequences in doing so.
As R.-J. Green argued, to draw conclusions about what
constitutes healthy psychological development on the basis
of a heterosexual population and to make suggestions for
intervention derived from this reflects a highly limited, eth-
nocentric, and potentially harmful view of psychological
maturity.
In Halford and Markman's (1997) Clinical Handbook of
Marriage and Couples Interventions, one of the chapters
deals with issues associated with GLB couples (Julien,
Arellano, & Turgeon, 1997). Checking the index to this
volume of over 700 pages reveals that this indeed is the
only chapter in the entire book that makes any comments
about GLB couples. Yet one may readily recognize the
relevance of the other, "mainstream" chapters, which deal
with such issues as cognitive and affective processes in
marriage, sex and relationships, violence and partner abuse,
the developmental course of couples' relationships, chil-
dren, restructuring marriages after infidelity, aging, couples
intervention and alcohol abuse, individual pathology and
distress, and physical health and relationships.
Determinants of Mental Health
One of the dangers of calling attention to the literature on
GLB issues is that one may reach the erroneous conclusion
that being gay, lesbian, or bisexual is intrinsically associ-
ated with psychopathology. GLB individuals are at greater
risk for suicide, are more likely to abuse substances, and
have a greater need for therapeutic services. Although
983
these findings do exist, there are also data indicating that
there are wide individual differences and that many GLB
individuals do not have such problems (McDaniel, Purcell,
& D'Augelli, 2001; Savin-Williams, 2001a, 2001b). In-
deed, there is a growing recognition within the GLB litera-
ture that research and clinical work in this general area
needs to attend to determinants of resiliency as well as
pathology.
As noted earlier, although GLB adolescents are more
likely to attempt suicide than their demographically compa-
rable heterosexual peers, the differences disappear when
one controls for such variables as substance abuse, depres-
sion, stress, and social support (Safren & Heimberg, 1999).
A study by Remafedi et al. (1991) of gay adolescents hav-
ing made suicide attempts revealed that their suicidality
was the result of family problems associated with their sex-
ual orientation, a finding that has more recently been repli-
cated by D'Augelli et al. (in press).
In a survey of older GLB individuals, it was found
that individuals with a history of having been physically
attacked because of their sexual orientation were more
likely to have had suicidal thoughts and actions than
those who were not victimized or those who had experi-
enced only verbal abuse (D'Augelli & Grossman, in
press). It was also found that a history of such physical
abuse was associated with reports of lower self-esteem,
greater loneliness, and poorer psychological adjustment.
When compared with victimization that is unrelated to
sexual orientation, hate crimes have been found to result
in more stress and drug abuse among lesbians (Des-
camps et al., in press) and more stress, anxiety, depres-
sion, and anger among both lesbians and gay men
(Herek, Gillis, & Cogan, 1999).
A study of what can buffer the negative impact of
victimization among GLB youths revealed that family
support is related to higher levels of self-acceptance,
which in turn is positively correlated with psychological
well-being (Hershberger & D'Augelli, 1995). Taken to-
gether with the findings noted above about the associa-
tion between suicide attempts and family conflict over
one's sexual orientation, one may safely conclude that
parental acceptance and family support play a significant
role in the lives of GLB individuals (see Goldfried &
Goldfried, 2001).
This consideration of mediators and moderators of men-
tal health among GLB individuals is obviously incomplete.
What little is offered is merely to illustrate that there is
nothing intrinsic to being lesbian, gay, or bisexual that re-
sults in psychological disturbance. There are clearly prob-
lems about being gay, lesbian, or bisexual, but the vast
majority of these stem from those of us who are
heterosexual.
984
What Can Mainstream Psychology Learn
by Studying GLB Issues?
Research and clinical work on GLB issues can have impor-
tant implications not only for understanding factors that
influence the lives of sexual minorities but also for shed-
ding light on human behavior in general. In many respects,
one may think of research with both GLB and heterosexual
individuals as providing a natural laboratory for learning
more about the relative importance of gender and sexual
orientation in understanding human behavior (Rothblum,
1994; Stacey & Biblarz, 2001).
For example, a common pattern of interaction seen in
marital conflict is the situation where wives pursue their
partners to discuss difficulties but husbands withdraw from
such discussions (Mien et al., 1997). This demand-with-
drawal pattern is related to the development of marital dis-
tress and is believed to be a function of gender differences
(e.g., men react with greater physiological arousal). How-
ever, such an interpretation needs to be reconsidered in
light of the findings that demand and withdrawal are also
seen in distressed same-gender partnerships, where the de-
mand-withdrawal pattern is unrelated to gender (Julien et
al., 1997).
Another example is seen in the research that has been
carried out on domestic violence. Koss et al.'s (1994) femi-
nist interpretation of partner abuse cannot easily be applied
to instances of abuse that occur within the context of same-
sex relationships. Although gender-based views of domes-
tic violence may nonetheless continue to have merit, multi-
ple pathways to abuse in intimate relationships must be
considered (M. P. Koss, personal communication, October
19, 2000).
A final example may be taken from the work that has
been done on eating disorders. Given the fact that society
places a greater emphasis on the physical attractiveness of
women than of men, it comes as little surprise that, in
comparison to men, women are more likely to have con-
cerns about their weight and are more likely to manifest
eating disorders. However, this emphasis on appearance
also exists within the gay community, and a study by
Siever (1994) found gay men have greater concerns about
their weight and are more likely to report eating disorders
than heterosexual men.
By attempting to understand human behavior on the ba-
sis of a limited sample, we as psychologists face the dan-
ger of drawing biased conclusions. This is very much like
the point recently made by Taylor et al. (2000), who sug-
gested that the well-accepted fight-or-flight response to
stress is biased in that it has been based on research carried
out primarily with male rats. When findings using female
subjects are considered, Taylor et al. argued, a more pro-
tective "tend-and-befriend" response may be seen as an-
other way of reacting to stress. By learning more about
November 2001 • American Psychologist
GLB issues, it is possible that mainstream psychology can
similarly extend its conceptual horizons in better under-
standing human behavior.
Closing the Gap Between Mainstream
and GLB Psychology
Despite the many advances that GLB individuals have
made in society and within the mental health professions,
there nonetheless continues to be a stigma associated with
doing work in this area. With some notable exceptions
(e.g., Davison, 1976; Hooker, 1957), most of the research
and clinical writing has been done by individuals who
themselves are GLB. Consequently, for them to decide to
work on GLB issues professionally involved their coming
out, as well as the possibility of putting themselves at risk
of being marginalized within the mainstream community.
Perhaps these factors contribute to the lack of incorporation
of GLB issues into mainstream psychotherapy practice and
research.
My own long-standing professional interests have in-
volved issues of integration. This has included the attempt
to create links among different theoretical approaches to
therapy (Goldfried, 1980) and also an interest in closing
the gap between clinical practice and research (Goldfried &
Wolfe, 1996). At this point in my career, I have decided to
focus on a third aspect of integration—the integration of
mainstream and GLB issues, particularly the goal of having
relevant GLB clinical and research issues incorporated into
mainstream psychology.
As noted earlier, family support plays an important role
in the lives of GLB individuals. With this in mind, a net-
work of family members within psychology who have
GLB relatives has been established—AFFIRM: Psycholo-
gist Affirming Their Gay, Lesbian, and Bisexual Family.
Not only does AFFIRM serve to provide open support for
its own family members but it also facilitates an indirect
contact with or exposure that others will have to GLB indi-
viduals. By having family members come out in this way,
it will increase the number of individuals who are able to
say they know someone who is GLB, which has been
found to decrease negative bias (Herek & Glunt, 1993).
Moreover, this network is dedicated to supporting clinical
and research work on GLB issues and to closing the gap
between GLB clinical and research work and mainstream
psychology. Work is currently underway to generate bibli-
ographies of those topics within the GLB literature having
relevance to mainstream psychology, including such areas
as adolescent development, teenage suicide, substance
abuse, family and couples issues, parenting, partner abuse,
aging, and psychotherapy. Once available, the bibliogra-
phies will be posted on the AFFIRM Web site (http://www.
sunysb.edu/affirm) to be used by mainstream professionals
in their teaching, research, and clinical work.
November 2001 • American Psychologist
Thanks to the Internet and e-mail, well over 200 psy-
chologists having GLB family members have joined
AFFIRM. What is dramatically evident from my e-mail
contacts with these family members is their enthusiasm for
the establishment of this network; their responses reflect far
more emotional support than I had expected. What is dis-
appointing, however, is the large number of family mem-
bers from whom AFFIRM has not yet heard. Given that
there are over 80,000 members of APA, one would think
that thousands of family members would qualify—mothers,
fathers, sisters, brothers, grandparents, aunts, uncles, cous-
ins, sons, and daughters. Although originally concerned
that more people did not respond to AFFIRM's announce-
ments, I came to realize that this, in fact, is symptomatic
of the gap between the mainstream and GLB professional
communities and thus illustrates the very need to close it.
AFFIRM hopes that it will be able to increase its num-
bers several-fold in the near future, enrolling motivated
psychologists having interest and expertise in many of
those areas in which relevant GLB issues continue to re-
main invisible to the mainstream profession. Once having
done so, the real work of AFFIRM will begin, namely,
actually closing the gap.
Author's Note
/ thank Anthony R. D'Augelli, Gerald C. Davison, Ritch
Savin-Williams, and Philip G. Zimbardo for their com-
ments on an earlier version of this address.
Correspondence concerning this address should be sent
to Marvin R. Goldfried, Department of Psychology, State
University of New York at Stony Brook, Stony Brook, New
York, 11794-2500. Electronic mail may be sent to
marvin. goldfried© sunysb. edu.
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