Adult Treatment Planner

Objectives and Interventions

• Describe fear, anxiety, and distress about confusion over sexual identity.
  • Actively build trust with the client and encourage his/her expression of fear, anxiety, and distress over sexual identity confusion.
• Identify sexual experiences that have been a source of excitement, satisfaction, and emotional gratification.
  • Assess the client's current sexual functioning by asking him/her about previous sexual history, fantasies, and thoughts.
  • Assist the client in identifying sexual experiences that have been a source of excitement, satisfaction, and emotional gratification.
  • To assist the client in increasing his/her awareness of sexual attractions and conflicts, assign him/her to write a journal describing sexual thoughts, fantasies, and conflicts that occur throughout the week.
  • Have the client rate his/her sexual attraction to both men and women on a scale of 1 to 10 (with 10 being extremely attracted and 1 being not at all attracted).
• Verbalize an understanding of how cultural, racial, and/or ethnic identity factors contribute to confusion about sexual identity.
  • Explore with the client how cultural, racial, and/or ethnic factors contribute to confusion about homosexual behavior and/or identity.
• Write a "future" biography detailing life as a heterosexual and as a homosexual to assist in identifying primary orientation.
  • Assign the client the homework of writing a "future" biography describing his/her life 20 years in the future, once as a heterosexual, another as a homosexual; read and process in session (e.g., ask him/her which life was more satisfying, which life had more regret).
• Verbalize an understanding of the range of sexual identities possible.
  • Educate the client about the range of sexual identities possible (i.e., heterosexual, homosexual, bisexual).
  • Have the client read The Invention of Heterosexuality (Katz); process the client's thoughts and feelings about its content.
• Identify the negative emotions experienced by hiding sexuality.
  • Explore the client's negative emotions (e.g., shame, guilt, anxiety, loneliness) related to hiding/denying his/her sexuality.
  • Explore the client's religious convictions and how these may conflict with identifying himself/herself as homosexual and cause feelings of shame or guilt (see Spiritual Confusion chapter in this Planner).
• Verbalize an understanding of safer-sex practices.
  • Teach the client the details of safer-sex guidelines and encourage him/her to include them in all future sexual activity.
• Verbalize an increased understanding of homosexuality.
  • Educate the client about the range of sexual identities possible (i.e., heterosexual, homosexual, bisexual).
  • Assign the client homework to identify 10 myths about homosexuals and assist him/her in replacing them with more realistic, positive beliefs.
  • Assign the client to read books that provide accurate, positive messages about homosexuality (e.g., Is It a Choice? by Marcus; Outing Yourself by Signorile; Coming Out: An Act of Love by Eichberg).
• List the advantages and disadvantages of disclosing sexual orientation to significant people in life.
  • Assign the client to list advantages and disadvantages of disclosing sexual orientation to significant others; process the list content.
• Watch films/videos that depict lesbian women/gay men in positive ways.
  • Ask the client to watch movies/videos that depict lesbians/gay men as healthy and happy (e.g., Desert Hearts; In and Out; Jeffrey; When Night is Falling); process his/her reactions to the films.
• Attend a support group for those who want to disclose themselves as homosexual.
  • Refer the client to a coming out support group (e.g., at Gay and Lesbian Community Service Center or AIDS Project).
• Identify gay/lesbian people to socialize with or to obtain support from.
  • Assign the client to read lesbian/gay magazines and newspapers (e.g., The Advocate).
  • Encourage the client to gather information and support from the Internet (e.g., coming-out bulletin boards on AOL, lesbian/gay organizations' web sites).
  • Encourage the client to identify gay men or lesbians to interact with by reviewing people he/she has met in support groups, at work, and so on, and encourage him/her to initiate social activities.
• Develop a plan detailing when, where, how, and to whom sexual orientation is to be disclosed.
  • Have the client role-play disclosure of sexual orientation to significant others (e.g., family, friends, coworkers; see Family Conflict chapter in this Planner).
  • Assign the client homework to write a detailed plan to disclose his/her sexual orientation, including to whom it will be disclosed, where, when, and possible questions and reactions recipient(s) might have.
• Identify one friend who is likely to have a positive reaction to homosexuality disclosure.
  • Encourage the client to identify one friend who is likely to be accepting of his/her homosexuality.
  • Suggest the client have casual talks with a friend about lesbian/gay rights, or some item in the news related to lesbians and gay men to "test the water" before disclosing sexual orientation to that friend.
• Reveal sexual orientation to significant others according to written plan.
  • Encourage the client to disclose sexual orientation to friends/family according to the written plan.
  • Probe the client about reactions of significant others to disclosure of homosexuality (e.g., acceptance, rejection, shock); provide encouragement and positive feedback.