Lesbian and Gay Youth: Care and Counseling

This comprehensive review of clinical care of lesbian and gay youth grew out of a conference in 1994 designed to identify primary care (including mental health) needs of this underserved population. The authors’ goal was to integrate a large database of research information into a format that could be used by clinicians, educators, parents, and advocates for sexual minority youth. They have more than succeeded in this daunting task. This volume is concise, readable, and scholarly. The coherence of this book reflects the increasingly rare phenomenon of a volume written by one or two authors rather than multiple experts. The emphasis throughout is on practical clinical application of research knowledge. To this end, the authors employ a variety of helpful tables and figures as well as seven appendixes of resources and protocols.

The book is divided into three sections. Part 1 is a thorough overview of pertinent background information about gay, lesbian, and bisexual adolescents. Complex definitions of sexual orientation, behavior, and identity development are explained as clinically applicable. For example, because of the vicissitudes of identity development, gay and lesbian youth are not likely to present initially as such to a primary care or mental health practitioner. In one study, 5% of surveyed youth reported homosexual behavior but only 1% identified themselves as homosexual. Clinicians who treat adolescents need to be particularly conscious of not making assumptions about heterosexuality.

Multiple stressors faced by sexual minority youth in learning to live with external and internal stigma are documented by the authors. In addition, they identify the primary developmental task for these adolescents, which is learning to adapt to and manage a stigmatized identity. A great deal of information is also provided on family adaptation to an adolescent’s coming out and therapeutic work with families of lesbian and gay youth.

In the second section, health maintenance and prevention strategies are reviewed. Health concerns, including sexually transmitted diseases, reproductive issues, and substance abuse, are reviewed. The chapter on mental health concerns is particularly helpful and relevant. Although not all of the studies reviewed involve ideal probability samples, Ryan and Futterman cite a recent population-based study finding that suicide attempts are up to four times more likely in lesbian and gay youth than in their heterosexual peers. This risk can be reduced by providing realistic information and increasing social support. Another chapter on mental health assessment treatment outlines psychiatric history taking with lesbian and gay youth, suicide assessment, and indications for psychiatric referral. The authors also point out research findings that reparative therapy—psychotherapy aimed at changing sexual orientation to heterosexual—may contribute to mental health problems and suicide risk (1).

Part 3 focuses on HIV infection, with an emphasis on counseling and prevention. Comprehensive risk reduction strategies are reviewed. This is a good antidote to the pessimism clinicians often express in regard to behavior change in adolescents. Another chapter in this section discusses medical and mental health care for HIV-infected adolescents. This is another area where psychiatrists who treat adolescents can have a major impact.

In summary, this book is an excellent addition to the library of almost any mental health practitioner. It is groundbreaking in not just reviewing familiar literature but also synthesizing literature on gay youth of color and providing new information on ethnic minority identity development in lesbian and gay youth. Clinicians who usually treat only adults will also find it helpful, in that much of the research applies to adult gay and lesbian patients as well as adolescents. I hope that this is the first edition of many for Ryan and Futterman on caring for this usually invisible population.