The number of people facing such discrimination is quite
large: Approximately 3 million older adults in the United
States identify themselves as lesbian or gay, and that number is
expected to swell to more than 7 million by 2025.
And research shows these clients are not getting the care
they need. The APA Task Force on Bias in Psychotherapy with
Lesbians and Gay Men, for example, found that older LG clients
may even be inadvertently mistreated by providers due to a lack
of knowledge about this population
and heterocentrism — the negative
attitudes and behaviors associated with
any deviation from heterosexuality.
Compounding these challenges is
that older LG adults are one of the
least empirically studied populations
in terms of their mental health needs
and adaption of psychotherapy to best
address those needs.
Historical and cohort effects
Among the most important concepts
to consider when working with LG
clients over age 50 is that all of them
lived through a time when their sexual
orientation was labeled immoral, illegal
and pathological. Homosexuality was
only officially removed from the
Diagnostic and Statistical Manual in
1973. Gay and lesbian people who
revealed their sexual orientation in
their younger years often suffered
significant psychological and physical
abuse from the larger community, including verbal harassment
and social isolation, as well as sexual and physical assaults.
These experiences may present themselves in later life as diffuse
anxiety, depression, somatic distress or even post-traumatic
APA Guidelines for Psychological Practice with Older Adults
encourage psychologists to take into account the impact of
being part of a generational age cohort (e.g., baby boomers)
because experience and attitudes vary among age cohorts,
including attitudes toward mental health services. LG baby
boomers experienced significantly different historical events
than did earlier age cohorts. For example, the oldest LG elders
came of age in the 1950s when President Eisenhower’s 1953
Executive Order #10450 called for homosexuals to be fired from
government jobs. Few LG individuals openly discussed their
status for fear of discrimination and violence since people who
were found to be engaging in same-sex behavior could be and
were sent to prison or mental hospitals. No federal or state laws
protected LG individuals from victimization. The mental health
establishment offered “treatments” to change homosexual
orientation through certain psychotherapies, electroconvulsive
therapy and hormones.
Previous generations of LG persons clearly experienced
enormous social pressure to suppress sexual expression or
hide sexual orientation. As a result, earlier generations of LG
elders — the now oldest-old LG elders — are more likely to
have married opposite-sex partners, and in late life have ex-spouses, adult children and grandchildren when compared with
LG baby boomers. Compared with their oldest-old heterosexual
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“I am gay.” A 65 year-old man, newly
admitted to a nursing home, scribbled this statement on a piece
of paper and slid it across the table to his new psychologist. The
man held his finger up to his lips, looked cautiously out into the
hallway and whispered “shhh” before taking the paper back and
ripping it into tiny pieces.
This incident happened just three years ago, despite significant
strides in gay rights in the United States. Fear of stigma and
outright discrimination in a variety of health-care, institutional
and social service settings continue to be documented among
aging lesbian and gay (LG) adults, even among those who live
in more socially progressive urban areas.