Coming Out with Compassion

October 11 is National Coming out day. Each year, I reflect on my experience as a queer individual and what my personal journey has been coming out. More recently, in my role as a clinician and supervisor,  I have been reflecting on what the process of coming out is like for others and how we as clinicians can view this process from a place of compassion.

The definition according to Merriam-Webster:

Coming out: [coming] into a public view; [declaring] oneself in a public utterance; [making] a debut, and publicly [declaring] one’s homosexuality or to openly [declaring] something about oneself previously kept hidden.

These definitions, and often societal views, reflect that coming out is an event that happens one time. Sometimes we view it as a linear progression, as evidenced in the model developed by Vivienne Cass. This model outlines six stages: Identity Confusion, Identity Comparison, Identity Tolerance, Identity Acceptance, Identity Pride and Identity Synthesis. In this model, like others, coming out follows a pattern. The initial stage suggests some awareness that the individual has a sexuality other than heterosexual while further stages that allows them to explore their sexual experiences, community belongingness, and associated cultures. However, what we are learning as clinicians and humans is that the process of coming out is a non-linear lifelong journey. Each person who identifies as a gender, sexuality or relationship structure minority (GSRSM) possesses a journey unique as their individuality.

For many, the concept of coming out may not fit into the definitions of closeted vs not-closeted. Experiences vary based on cultural factors including race, ethnicity, gender, age, region, etc. For most the act of coming out may be a near daily experience. While we often conceptualize coming out as revealing our minority identity to ourselves followed by our biological and chosen family, we often forget that with each interaction we face a decision as to whether it is safe to reveal our authentic selves to others. In our heteronormative society, clinicians often do not realize the stressors faced by GSRSM. Each day, the assumption is made that an individual is cisgender and heterosexual until otherwise reported and verified. This assumption leads to aggressions and micro-agression, which include risks in the living, working, and social environment.  As such, individuals may feel a constant need to have to re-out themselves to normalize their existence and experience. As a middle-aged individual who has been “out” since I was a teenager, I find myself outing myself over and over again to this day. Each time I am faced with these questions:

  • Am I safe?

  • What risk am I taking?

  • What benefit will I gain?

  • Will I be accepted?

  • Will I be placed in danger?

As I have moved from region to region, experience to experience, I have adjusted my willingness and ability to “out” myself, curbed the amount of “outness” I have displayed based on my work or social setting. The act of coming out never seems to end.

So where does that leave us as clinicians? What is our role? Ask yourself as a clinician,

  • What knowledge do you currently hold about GSRSM communities? 

  • What has your own experience been with your gender, sexuality or relationship structure development?

  • What are your beliefs about the coming out process?  

When working from a position of compassion, I invite you to be flexible. Allow your clients to experience fluidity, a certain level of feeling uncertain and the ability to weigh risks and benefits in each of their situations. Allow them to guide us as to what works for their values and personal boundaries. Ask questions like “What does being queer mean to you?” or “What does being gender fluid mean to you?” and accept that their answers are genuine and authentic and that they are the experts on them.

I challenge you to look at your own messages of hetero-normativity and gender-normativity and ask how that affects your practice? How does it drive your assessment style and the interventions you choose? Ask and listen to your clients about what labels they use and what they mean to them. Reflect back what you have heard. Validate their experience. Take step back and wonder what if you said, “Hi my name is ____ and I use ____ pronouns”? How would that change the experience of your client? Practice being vulnerable with your clients and explaining when you do not know something related to the GSRSM experience. Do not use them as experts but instead ensure them you will learn to help support their experience. This step away from our position as experts, removes power and embodies a message of compassion, minimizing the risk of judgement and shame.

The key to being compassionate in our work is to remember that it is not the clinician’s job to direct a client’s coming out process. This may require us to challenge our clinical beliefs that being out is always within the best interest of the individual we serve. In honor of National Coming Out Day, consider, are you being as compassionate as you can be towards yourself and your clients? Are you accepting of your own journey and room for growth as an individual, in turn modeling acceptance to those you support? I know that despite being a queer female presenting individual who has lived and  worked with GSRSM for decades I still have so much to learn. About myself, my clients, my community and my world and when I honor this, I grow as a human and as a clinician, making my office safe for those who need it.