Brief Cognitive Behavioral Family Therapy Following a Child's Coming Out: A Case Report

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Abstract

Few interventions have been proposed for the treatment of families following a child's disclosure of nonheterosexuality. To address this gap in the literature, the current paper outlines a brief cognitive behavioral family treatment (CBFT) for families negotiating the coming-out process and illustrates this approach with a case example. Parents' attributions, beliefs, and expectations are explored and challenged. The family is exposed to increasingly salient topics and directed to increase the frequency of positive family experiences. Lastly, the family is taught specific listening and problem-solving skills to bolster adaptive family communication. This paper is among the first to apply an empirically supported therapeutic framework to support family adjustment following a child's disclosure of sexual orientation. The potential usefulness and limitations of this CBFT application are discussed.

Section snippets

Parental Reactions to Their Child's Coming Out

There is a growing body of literature examining the coming-out process from family-based perspectives (e.g., Heatherington and Lavner, 2008, Willoughby et al., 2008). This research is largely guided by an overarching question: Why do some families deteriorate upon learning of a child's nonheterosexual orientation, while other families adapt and strengthen? Considering the heterocentric social climate of the United States, it is not surprising that parents, like most Americans, may develop core

Existing Treatments

Very few interventions have been proposed for the treatment of families following a child's coming out. Within existing case reports, therapists have typically relied on supportive approaches, which facilitate family adjustment through active listening, reflection, and validation. While, anecdotally, supportive approaches appear to have some utility, these interventions lack a clearly articulated theoretical framework. Additionally, the lack of standardized treatment protocols for these

A Cognitive-Behavioral Family Therapy Approach

Researchers have conceptualized coming out as a family-based crisis that has the potential to disrupt family boundaries, beliefs, and expectations (e.g., Crosbie-Burnett et al., 1996, Willoughby et al., 2008). In fact, the disruptions arising from a child's coming out appear to closely resemble those of other family-based crises, such as a parental divorce, sudden geographical relocation, or disclosure of a teenage pregnancy. Existing evidence supports CBFT as an effective intervention for

Family Characteristics and Referral Issue

Wendy and Angelo Marano1, a married couple of Italian decent in their early 50s, presented at the child and adolescent psychiatry outpatient clinic seeking support in coping with their 18-year-old son's (Peter) coming out. Peter was attending his freshman year of college (out of state) and was not initially available to participate in the therapy. Mr. and Mrs. Marano reported struggling with Peter's nonheterosexual orientation, which he had

Intervention Process

Following the initial intake, Wendy and Angelo engaged in four, 50-minute couple sessions. Peter planned to join the final two sessions of treatment when he returned home for summer vacation. See Table 1 for a brief outline of the session structure and intervention process.

Results

Findings regarding treatment outcomes for the Marano family are detailed here. Treatment outcome was assessed in the following ways: (a) clinician ratings following each session using the Global Assessment of Relational Functioning (GARF) Scale from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994); (b) subjective report of all family members at the end of Session 6; and (c) subjective impressions from the treating clinician following

Discussion

This report is among the first to apply an empirically supported therapeutic framework in supporting family adjustment following a child's coming out. Although the effectiveness of the above-mentioned intervention has not been explicitly tested, it employs empirically based CBFT principles which have been shown to be effective in treating families in crisis (e.g., Dattilio and Freeman, 2000, Friedberg, 2006). Additionally, the treatment employed here addresses several factors known to predict

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