Family of Choice and Relationships

Providing support for LGBT clients and their families of choice is a crucial element of substance abuse treatment, just as it is for all clients. A family of choice is made up of individuals who are significant to the client, and it needs to be included in any assessment. It includes individuals who have died or are no longer an immediate part of clients’ lives, sometimes because of addiction, HIV/AIDS, or other life events. A family of choice does not necessarily exclude blood relatives. By definition, it includes those who, by their support, nurturing, and understanding, have earned a significant place in the LGBT individual’s life.

Substance abuse counselors and treatment centers need to create a safe place for healing. This safety needs to include respect, understanding, and support for the life partners and significant others of their LGBT clients. It cannot be overstated that these individuals must be included in services similar to those offered to the spouses of heterosexual clients.

In order to work effectively with LGBT clients, substance abuse treatment counselors need to have some understanding of the dynamics of LGBT interpersonal relationships. This includes awareness of the internal and external problems of same-sex couples and the diversity and variety of relationships in the LGBT community. As noted previously, not all individuals in relationships with people of the same sex, or engaging in same-sex behavior, consider themselves lesbian or gay. The counselor needs to be sensitive to the individual’s self-identification. Counselors also need to beaware of the lack of universal terminology with regard to significant others in the LGBT community. The terms “lover” or “significant other” can mean different things depending on cultural or generational differences. Interpersonal relationships span a spectrum of emotional significance that is as diverse as LGBT communities. Although many individuals seek out a life partner, others are single or may find themselves in nontraditional arrangements. Counselors need to be aware of their own biases when working with individuals who—as a result of their affections—find themselves outside the cultural norm of a heterosexual, monogamous, and legally sanctioned marriage.

Lesbian, gay, and transgender (LGT) individuals with a previous history of opposite-sex relationships add a new level of complexity to their relationships that approaches that of bisexual individuals. Like their heterosexual counterparts, some LGT individuals maintain close contact with their opposite-sex partners. Others consider such relationships to be part of a previous “life” before coming out.

One particular stressor for LGBT individuals in interpersonal relationships is the level of comfort with one’s sexual orientation. A couple could, for instance, consist of one person who is closeted while the other is out. When couples are at different stages of self acceptance regarding sexual orientation, it can be a source of great tension within the unit.