Despite an extensive history of punitive practices towards what we know today as the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, LGBTQ people have served in the United States military since its inception (GSAFE, 2018). Those LGBTQ Veterans who served during World War II, the Korean War, and the Vietnam War did so at a time when the military defined homosexuality as a mental disorder, with support from the organized medical community (e.g., APA). Disregarding a 1957 Navy report concluding that there is no evidence to support homosexuality being incompatible with military service (GSAFE, 2018), the Department of Defense banned gay people from serving in the military in 1982. This resulted in the discharge of nearly 17,000 men and women during the 1980s (U.S. Government Accountability Office, 1992). Under the compromise that became known as Don’t Ask Don’t Tell (1993), concealing sexual orientation status became a requisite to service, with any suspicion of same-sex behavior potentially resulting in involuntary discharge. Over 13,000 Service members were discharged under the policy between December 1993 up until its official end in 2011 (Gates, 2010). Today, the battle for transgender persons to serve openly in the military continues, with the ban having been repealed in 2016, but the Supreme Court recently allowing the Trump administration to prohibit most transgender people from serving.
This abbreviated history is offered to contextualize the strength and resilience that has been required of LGBTQ people to pursue military service. In my opinion, to competently treat LGBTQ Veterans, Service members, and their families, one must be aware of the extensive record of systemic oppression within the United States, the Department of Defense, and the medical and mental health community. Understanding the role of the mental health field in previously supporting discriminatory policies towards LGBTQ people is necessary to make meaningful change and to build real trust with our current LGBTQ Service members and Veterans.
As a result of a dynamic social landscape, research on LGBTQ military-connected couples is in its infancy. To my knowledge, the majority of the current research on LGBTQ military-connected couples are case studies and focus on those in same-sex relationships. For example, Blount, Peterson, and Monson (2017), completed 15 sessions of Cognitive Behavioral Conjoint Therapy for PTSD with a same-sex active-duty military couple. The couple reported clinically significant improvement in PTSD symptoms in the Service member, which were maintained at the two-month follow up, suggesting CBCT for PTSD can be used with same-sex military-connected couples. Although promising, more research is needed to further establish best practices. Due to limited research, much of our understanding of military-connected LGBTQ couples must be generalized from civilian couples.
Rotosky and Riggle (2017) conducted a review of the empirical literature from 2000 to 2016 on same-sex couple relationship strengths. The researchers reviewed and synthesized 66 articles, finding interrelated positive relationship processes and characteristics of same-sex relationships. With regard to relationship processes, the researchers found that same-sex couples viewed mutual respect and appreciation of individual difference as important to the quality of their relationship; were able to generate positive emotions (e.g., humor) and interactions (e.g., validation) even in the face of stigma and discrimination, and; were skilled at effective communication and negotiation. Positive characteristics were also assessed across the reviewed studies. Several studies found that same-sex partners reported higher levels of perceived intimacy compared to their different-sex counterparts, and that same-sex partnered women rate their relationships as significantly more intimate compared with other couple types. Another strength found was the commitment to and expression of egalitarian ideals (e.g., equal division of roles, responsibilities, relationship maintenance behaviors, etc.), which was linked to relationship satisfaction and stability (Kurdek, 2007). Outness was a unique characteristic considered to be an important strength for same-sex couples (LaSala, 2000; Patterson, Ward, & Brown, 2013), providing opportunity to validate their relationships and yielding higher relationship quality.
Thus, the strengths of LGBTQ couples are abundant and in many ways, have developed in response to socio-cultural discrimination and rigid enforcement of constructs that do not capture the diversity of human sexuality and gender. Although LGBTQ military-connected couples have been subjected to tremendous rejection and stigma, they also contain a relational resilience that is worth honoring and exploring in couple's therapy. It is not enough to treat LGBTQ military-connected couples like all other military-connected couples because there is a unique experience to this subpopulation that must inform every aspect of the assessment, formulation, and treatment process. LGBTQ people have a different experience within our social context that is nuanced and shapes not only their individual identity, but also their relational worlds:
“If you don't see my gayness, then you don't see me. If it doesn't matter to you who I sleep with, then you cannot imagine what it feels like when I walk down the street late at night holding her hand, and approach a group of people and have to make the decision if I should hang on to it or if I should I drop it when all I want to do is squeeze it tighter. And the small victory I feel when I make it by and don't have to let go. And the incredible cowardice and disappointment I feel when I drop it. If you do not see that struggle that is unique to my human experience because I am gay, then you don't see me. If you are going to be an ally, I need you to see me.” – Ash Beckham (2014)
For those cisgender and/or heterosexual therapists who identify as allies or who are in pursuit of becoming allies, I encourage you to not only be knowledgeable of the extensive impact of minority stress on the LGBTQ community and the long history of oppression within this country, but also to recognize the strengths and resilience of a community that has never stopped serving or loving despite titanic opposition. LGBTQ couples have developed internal strengths to cope with minority stress (e.g., positive reframing and meaning-making) and virtues (e.g., respecting individual difference, humor, and spirituality) that have contributed to relationship resilience and must be appreciated by the therapist. Providers must also challenge their own understanding of binary gender roles because these often do not apply to LGBTQ couples and such egalitarianism is an important strength to many LGBTQ relationships.
More research is needed to understand the unique strengths and challenges faced by LGBTQ military-connected couples, particularly transgender Service members and their partners. For those who do not know where to begin, I recommend starting with an analysis of your own identity, beliefs, and internalized biases; followed by an examination of the systems that have constructed gender and sexuality as we have come to know them in the United States. And remember, providing affirmative care to our LGBTQ military-connected couples is a direction and one that requires humility and the value of lifelong learning.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Kaleigh DeSimone, Psy.D., is the Center for Deployment Psychology's Military Internship Behavioral Health Psychologist at Tripler Army Medical Center, Honolulu, HI.
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