Sources by Which Students Perceive Professional Counselors’ Effectiveness

Sep 7, 2014 | Article, Volume 2 - Issue 1

Michael W. Firmin, Richard A. Wantz, Ruth L. Firmin, Courtney B. Johnson

Using qualitative research methods, interviews were conducted with college students regarding the sources they
used in generating perceptions of professional counselors. Respondents believed that information sources such as word of mouth, media sources and personal experiences were responsible for their understandings of professional counselors. The findings have applications for leaders in professional counseling organizations. Common knowledge characteristics, public perceptions, counselor identity and advocacy are discussed.

Keywords: perceptions, professional counselors, information sources, counselor identity, advocacy

Perceptions do not equal reality. However, perceptions eventually can lead to what reality becomes in time. All professions possess public perception. When someone refers to doctors, lawyers, dentists, and other specialized occupational groups, images are created in our minds. These percepts possess varying degrees of reality, of course, but the effects of such images are cogent nonetheless. Of particular interest to the present study is the perception of human service personnel, including professional counselors.

As a whole, the human service profession has landed itself on the positive side of the public’s opinion spectrum (Nunnally & Kittross, 1958). McGuire and Borowy’s (1979) research showed a continuum of perceptions held by the lay public regarding a wide range of professionals who worked with mental illness. Those occupying the fields of nursing, physicians, counseling psychologists, social workers, psychiatric nurses, psychiatrists, and clinical psychologists received the highest rankings.

Undergraduate students’ opinions regarding effectiveness of various human service providers for helping mental health consumers were reported by Tse, Wantz, and Firmin (2010) and Wantz and Firmin (2011). Participants in these studies rated human service providers’ effectiveness more positive than negative. Professional counselors and psychologists were rated more effective with providing mental health services than other human service providers.

Richardson and Handal (1995) found the general public viewed psychotherapy as a reasonably effective means of treatment for between 25 and 50% of all cases. Most people also recognized that services of less traditional human service providers, such as marriage and family therapists, also could be used effectively in relation to particular disorders. Psychiatrists and psychologists, however, were perceived as having higher levels of competence when addressing mental health issues (Schindler, Berren, Hannah, Beigel, & Santiago, 1987). Educational attainment (Dotson-Blake, Know, & Holman, 2010), chronological maturity (Erikson, 1963; Oliver, Reed, & Smith, 1998), and psychosocial development (Tinsley, Hinson, Holt, & Tinsley, 1990) have been reported to be positively correlated with perceived benefits of counseling.

Murstein and Fontaine (1993) found familiarity of the general public to be greater concerning physicians, clergypersons, and psychiatrists than it was in their knowledge of psychotherapists and psychologists. Consequently, of the two, psychologists were the source the general public was most likely to use when recommending a human service provider. Also reported, the most common reasons for which clients sought mental health professionals were mild depression, marital problems, and child-rearing issues. A generation ago, Gelso, Brooks, and Karl (1975) reported mental health consumers’ overall preferences to be for counseling psychologists and psychiatrists.

Sharpley (1986) purported a tendency for mental health consumers to separate human service professionals into two categories, each entailing distinct perspectives. First, private practice and fee-for-service providers, psychologists and psychiatrists being the most prominent, were viewed as those who were most competent in treating mental illnesses. Second, public-utility and non-fee-demanding professionals, of which social workers and counselors prominently emerged, were perceived as being more practical and apt in providing service to the average person when addressing emotional problems.

Among the various human service professionals, counselors are of particular interest to the present study. Sharpley, Bond, and Agnew (2004) indicated that the public views counselors’ roles to be primarily listening, supporting, and helping to solve problems. While 79% said counselors were needed, and the same number indicated a willingness to pay for services provided, survey respondents personally were likely to consult a counselor concerning only 13–20% of the problems they faced. Participants also reported benefits of counseling to include having an impartial person to listen and help clarify, as well as having a facilitator for problem-solving, and meeting in a safe, confidential environment.

Fall, Levitov, Jennings, and Eberts (2000) described the public’s expressed general confidence in professional counselors’ abilities to treat “less serious” cases, but less confidence when treating cases which were perceived to be at higher levels of seriousness (e.g., psychopathology). These findings are congruent with those found by Fall, Levitov, Anderson, and Clay (2005) specifically studying the perceptions of the African-American population. In both studies, the participants expressed significantly greater levels of confidence in the abilities of psychiatrists when addressing severe issues, such as psychotic depression or post-traumatic stress disorder. Findings further showed that doctoral-level counselors were perceived similarly to clinical psychologists, while both studies showed that in every case professional counselors with doctorates were preferred over those with only master’s-level education. Wantz, Firmin, Johnson, and Firmin (2006) reported on university student perceptions of high school counselors. This qualitative study found college students reported high school counselors as having similar empathic and desire to help skills as licensed professional counselors.

Dixon, Vrochopoulos, and Burton (1997) reported the underrepresentation of counseling psychologists in introductory psychology textbooks, showing counseling to have significantly fewer references than clinical, school, and industrial psychologists. Likewise, Firmin, Johnson, and Winkler’s (2005) research showed almost no references to professional counselors in general psychology texts. Consequently, we conclude that while the public generally possesses positive perceptions of professional counselors, their presence is kept somewhat cryptic by the gatekeepers. College-educated students depend on introductory psychology texts to frame for them professional domains and functions among human service professionals.

As counselors have achieved professional status through licensure over the last two decades, identity confusion has been demonstrated by the practitioners within the field (King, 2006). Inevitably, this perplexity has trickled down to the minds of mental health practice consumers regarding distinctions and roles of professional counselors. Consequently, while the public generally likes the construct of who they think of as counselors, they also are unsure of these professionals’ roles (Butterfield, 1989).

Decades ago, Dahlem (1969) called for the vital need to research the general publics’ perception of counselors’ images and role perceptions, compared to counselors’ self-perceptions. He stressed the importance of clarifying consumers’ understandings and perceptions in relation to the success of the providers. Gelso and McKenzie (1973) followed up, studying ways in which students were informed of counselors’ available assistance. Students receiving only written information about hypothetical problems appropriate for counseling were less likely to experience changes of perceptions. This suggested that the most effective way to impact students’ impressions concerning counselors would be the presentation of written and oral information.

Narrowing the scope, the present study updates this important research inquiry. Specifically, our interests were to explore how college students, as potential consumers of mental health services, came to their understandings of counselors’ professional competence. That is, how effective do students perceive professional counselors to be? Obviously, since such perceptions are tied to students’ ultimate use of counselors’ services, the answers to the research question have significant implications for personnel working in college counseling settings.

Method

In accomplishing the study’s aim of assessing how college students generate their perceptions of professional counselors, we considered a number of potential research designs. While quantitative methods such as surveys would provide us with a relative breadth of understanding in this area (Patten, 1998) and this would be valuable, we believed such an approach would not be as apt as a qualitative design. Generally, quantitative approaches answer “what” or “how many” types of questions (Sarafino, 2005). However, we were more interested in knowing answers to “how” and “why” types of questions. These, by and large, are best answered via qualitative designs (Atkinson, Coffey, & Delamont, 2003).

At the outset, we are explicit regarding our decision in using an atheoretical approach to the qualitative method. Significant and heated debate presently exists in qualitative circles regarding whether one should or should not use theory—and if so, what that role should be. Originally Glaser and Strauss (1967) advocated that atheoretic, inductive approaches were the only means of generating a grounded theory. Later, Strauss and Corbin (2008) purported that theory was legitimate and useable for some qualitative research designs. Glaser (1992), however, vehemently opposed this departure from the classical approach indicating that researchers must exercise disciplined restraint in holding back theory when generating or interpreting results.

Obviously, we are not going to abate the controversy in this article, but we do wish to be explicit in reporting our commitment to classical grounded theory. That is, philosophically we believe that phenomenological studies such as the present one should be conducted inductively—holding theory at bay. While we understand the implications and even potential limitations of this approach, we believe it to be most apt, nonetheless.

A sample of 26 students was drawn from a general psychology course (16 females and 10 males). The institution was a selective, private comprehensive university located in the Midwest. Departing from traditional criterion or purposeful sampling most often used with qualitative research (Seidman, 2006), we used random sampling for this study because we wished to enhance the external validity of our findings as much as feasible. That is, the trade-off of expanded generalizability was believed to be worth the expense of potentially less rich descriptions through specifically selected students. Since the general psychology course was part of the liberal arts core curriculum at the institution, our sample reflected a relatively wide cross-section of majors, included students who were freshmen through seniors, and participants’ ages ranged from 18 to 22 years of age. Interviews were tape recorded and later transcribed for analysis. In writing the present article, we used respondent pseudonyms for reading clarity.

We utilized a semi-structure method in conducting the in-depth interviews. We used staple constructs for generating questions, but also allowed students to deviate in their replies, enabling them to tell their own stories and share perceptions inductively. Following Firmin (2006a), two waves of interviews were conducted. That is, all participants were interviewed twice—with transcription and coding occurring in between the interviews. This allowed for constant comparison of the data and dialogue among the researchers for generating potential codes.

When analyzing the interviews, we used an open (Maxwell, 2005) coding, inductive process (Marshall, 1999). Since we located no studies published on this topic, axial coding was not practical and open coding was more consistent with the study’s exploratory aim. Frequent meetings among the article’s authors occurred and this process facilitated coding, providing verifications for consistency of analysis. When generating potential codes, we read through the transcripts, utilizing constant comparison methods (Bogdan & Biklen, 2007). This involved continuously comparing the transcripts to one another, looking for any repeating words, phrases, or constructs that were common among the participants. In order to keep the data manageable, some similar categories were collapsed into major categories. NVIVO qualitative research software also was used to help analyze data. This program helps to manage relatively large amounts of transcript documentation as well as aid in the generation of reliable themes across multiple participant data sets. This technology enhanced human capability, and it did not replace the role of subjective judgments required to conduct intuitive work (Lewins & Siver, 2007). Following Gay, Mills, and Airasian (2009), the process of transitioning from codes to themes involved asking key questions, conducting organizational review, visually displaying the findings, and concept mapping.

The research team’s dialogue regarding potential thematic outcomes enhanced the study’s internal validity. Naturally, one researcher can appropriately analyze data and provide apt findings. Nonetheless, the assurance of valid findings often is enhanced when multiple qualitative researchers participate in the analysis process (Ryan & Bernard, 2003). We included in this article only those themes on which the entire research team concurred. The study’s internal validity also was strengthened through generating a data trail (Daytner, 2006). This involved generating direct connections between each reported theme in our transcripts through identifying specific paragraphs within the interview conversations. Data trails can be useful to those who wish to check the validity of our reported findings or who hope to someday replicate or advance our present study (Firmin, 2006b).

Third, member checks (Merriam, 2002) were applied with various research participants. This is a qualitative research technique whereby we shared our findings with research subjects, garnering their feedback regarding how reported results aptly reflected their reported perceptions during the interview process. Each of the individuals with whom we checked commonly agreed with our reported results. Fourth, we strengthened the study’s internal validity by including participation from an independent researcher with renowned expertise in qualitative methodology (Flick, 2006). This expert appraised the steps at each stage of the study, the legitimacy of our process, assessed our data audit, and provided analysis regarding linking the transcripts data with the results. Fifth, saturation (Silverman, 2006) occurred when analyzing the transcript data. Specifically, after approximately 24 interviews, our participants generally shared similar sentiments, with few fresh insights added as subsequent interviews were added to the sample. In the qualitative tradition of experts such as Guest, Bunce, and Johnson (2006) and Neuman (2006), we believe our sample size was both ample and appropriate for the context of this specific study.

In summary, internal validity is a critical component in delineating appropriate qualitative research (Cope, 2004). Weightier confidence may be placed in the reported themes, that they adequately represent the general sentiments of the research participants when particular, deliberate steps are taken. Both in the study’s design and its implementation, we believe this project demonstrates rigor by established qualitative research standards (DeWet & Erasmus, 2005) and an apt grounded theory of the data collected (Lundberg & Young, 2005).

Results

Upon examination of the interviews, several themes emerged from the coded transcripts. Primarily, respondents discussed their awareness of sources such as the media, word of mouth, and personal experience in the development of opinions regarding professional counselors. Further, respondents discussed characteristics of a “common knowledge” upon which consumers draw in their utilization or hesitancy of seeking counseling services. Finally, responses delineated the perceived effects of this common knowledge on the reputation of counseling.

Three Sources
Repeatedly, respondents spoke of three main sources on which they depended in generating their opinions of professional counselors’ effectiveness. Respondents particularly mentioned the contribution of media sources such as radio, newspapers, television, and movies, along with the more personal and implicative sources of word of mouth and personal experience. Considered holistically, this amalgamated into a nebulous resource of common knowledge. One respondent defined common knowledge as “general sources,” implying the prevalent accessibility of this information.

Consistent with the sample’s generational factors, responses repeatedly indicated the role of the media in their concept formation of who professional counselors are and what they do. Janet explained that “common knowledge would probably be just things they’ve heard on TV or seen on TV,” revealing the expectation of what a professional counseling session should theoretically cover and how a session should appear. Media also sharply influenced perceptions of what a counselor and client should look like (i.e., personal dress and hygiene) and even where these services are located (e.g., in a swanky hospital wing or in urban city slums). Pete specifically mentioned the impact Hollywood had on the formation of his own perceptions, indicating no coincidence in the congruity of college students’ expectations with media depictions.

Fortunately, respondents spoke with a voice of relative discernment, aware of the possible slants injected into information relayed by the media. Injecting a sense of humor, Jason admitted: “I know I was watching TV the other day, I think it was Growing Pains, or something like that, and they were talking about it [counseling] so that’s how I know.” Not credulous to the media portrayal, he continued: “Like they have no problems in life, everything’s going smooth for them . . . people that have no problems and are like happy all the time . . . that’s not true.” While not all respondents explicitly expressed this intuition, they generally did note the connotations associated with counseling by the media. For example, Coleen noticed the subliminal messages as she watched movies or television shows: “It’s usually like TV and movies just have different characters in them and it usually seems like a negative type thing. . . I think that they make it seem like it’s [counseling] a weird place to go and it’s not a fun thing.” Clearly, the media is not a bias-free information source, but requires active examination on the part of the viewer.

Numerous respondents mentioned the place that word of mouth had in the formation of their perceptions about counselors. Where personal experience waned and media fell short of credibility, respondents turned to testimonies of people they know who were counseled first-hand and held credence. When asked to describe sources of common knowledge regarding her perceptions of counselors, Barb offered: “I think a lot of people would be, maybe from people they know, who have been to one, who are one [professional counselor].” Respondents feel that no matter the strength of the connection, be it from a friend-of-a-friend or from the mouth of a professional counselor, hearing of others’ encounters considerably influences perception formation. Making judgments on topics with which respondents are personally unfamiliar (i.e., no personal experience in counseling) is alleviated when backed by the testimony of personal references.

Dan mentioned the input of “the whole movies and TV and media” in passing, but pointed to word of mouth as the primary information hub about how he developed his percepts regarding counselors. His assertion that word of mouth is the primary means rests on another assumption, “I’m sure probably the majority of the people don’t go to counseling,” highlighting that where personal experience lacks, the information network through word of mouth becomes prominent in concept formations. Dan concluded: “I think that in general it’s the word of mouth because you always know someone who’s been through something or doing something and has had to go to counseling.” Respondents believed that personal encounters with counselors by their friends were a rarity, and in a sense a commodity, taking what they heard at face value. As such, their collections of personal testimonies were typically sparse. Johanna considered word of mouth to be the prominent common knowledge source when thinking about counselors, as she stated: “I haven’t really read up on them or anything, but just based on what people have said, that’s where I’ve gotten my perspective from.” Even more, Johanna looked to her immediate context: “For me it would be more of adults, like parents, parents’ friends, stuff like that.” Speaking from the periphery, students gain perspective based on other’s comments.

When accessible, respondents relied on personal experience and interactions of acquaintances as their main contributors to their knowledge base about professional counselors. No matter how insignificant the interaction, respondents preferred personal encounters or those of close friends, more so than media or other sources, in their concept formations. For example, Emma drew on memories from elementary school: “Just like experiences in elementary school where counselors came around and talked like ‘don’t do drugs and things like that.” Respondents readily admitted their recollections may be somewhat “fuzzy,” but nonetheless preferred these to more broad sources.

The context of “home” was imperative for perception formation about counselors among respondents in our sample. Specifically, respondents heavily relied on past experiences to formulate opinions about new concepts or in discussing unfamiliar territory. Carla offered this insight: “I suppose it could be something that has come from their background or their family life.” Familial beliefs are known to possess cogent influences in multiple life domains such as politics, religion, prejudice, etc. In the present context, our students suggested that generational influences play a moderating role in perceptions of professional counseling.

As the majority of respondents could not draw from personal experience, the testimony of friends often was their closest connection to professional counselors. Stephanie mentioned that common knowledge was a salient influence in how she came to think of counselors. Later, she elaborated this could be from talking with “friends that went to go see a counselor” and who could fill in the gaps of her understanding. Randy affirmed the power generated when he will “hear other people’s experiences.” Obviously, respondents in our sample could not judge the relative quality of their friends’ experiences or the degree of truth represented by their friends’ accounts. But hearing what their friends told them left indelible impressions, nonetheless.

Common Knowledge Characteristics
Upon examination of their information sources, respondents reflected on the characteristics of their sources. Specifically, respondents mentioned that their knowledge about unfamiliar topics such as professional counselors may have little-to-no factual basis or may be unreliable. Mandy shared that respondents evaluate counselors by “just what they think they know. It might not necessarily come off of anything.” Respondents often were aware of this vulnerable reasoning, but when asked to offer their opinions, they drew on the ambiguous common knowledge anyhow. Linda stated her perception that this concept was “possibly general statistics or people’s assumptions about professional counselors, not necessarily what’s true.” In consideration of the often inaccurate portrayal of counselors through movies, magazines, and additional sources of media, these assumptions may differ widely from reality. Kevin offered this reasoning about how common knowledge affects perceptions about counselors: “People . . . think they know stuff about stuff, and really don’t. . . . So that’s why the majority of people don’t even know much about counselors and stuff like that. They hear one thing, and generalize it about everybody.” The tendency to generalize can be potently beneficial, depending on the accuracy of the source, of course. This principle has important ramifications for the development of counseling as a potential profession.

A second characteristic of common knowledge in our study is an inability of participants to recall the sources from which the information comes. Clearly, when making decisions such as choosing counseling services, knowing potential sources behind the motivation for utilizing them are important. Lori mentioned that students often rely on “things from a long time ago that they may not remember specifically” in order to evaluate the positive or negative effects of seeking professional counseling services. Similar to Rob’s tendency to generalize, our subjects’ distant recollections were said to be formative in their perceptions, however accurate they may or may not be. Steve elucidated that this source of common knowledge may be far removed from the true source: “Like second and third hand information about people who have gone to counselors, again television and movies, the joke from the Sunday newspaper, you know.” Perceptions for these students are formulated from a conglomeration of sources, credible or not, evidently even from the comics section of the Sunday newspaper.

While respondents relied heavily on word of mouth, Jordan did speak of the possible flaws in this resource: “I guess from other people talking to them about it. You can’t just know, obviously, but obviously they don’t remember where they’ve heard it from.” While acquaintances and peers may be eager to share their opinions, our subjects evidently often were unable to support their opinions with factual sources. Cathy concurred in stating that common knowledge of counselors is generated by “probably a little bit of what they fill in, what they assume.” Not only are their potential sources emitting their own assumptions, but the respondents fall prey to the same tendency in order to compensate for lack of information. Sandy further clarified, “it may just be, I assume they’re this way, but they really didn’t base that off of anything,” again revealing the flaws in their apt perception formation.

Effects of Common Knowledge
Without doubt, the lack of verifiable validity found in common knowledge about counselors creates powerful effects for the advancement of counseling as a profession. Namely, not only is the reputation of services potentially marred, but respondents also may be less likely to seek out counseling when needed due to their incorrect assumptions and faulty sources. Respondents reported feeling that the media, through movies, magazines or books, too often generates negative connotations with professional counseling images. Rachel noted: “I think that it [media] negatively affects their perception of professional counselors.” When prodded to share more, she continued: “A lot of times in TV and in movies they’re portrayed as odd people so I guess that’s the image that a lot of people have, because going back to their philosophy in the way they conduct their counseling.” Most definitely, “odd” is not a positive connotation to associate with professional counseling. In times of need, respondents likely will not seek out a source they consider to be odd. Larry offered a similar insight in his comment: “Probably that they’re just people who sit there and they try and make you talk to them even though you don’t want to and, I don’t know, probably the same thing that they would be with a psychologist.” This statement is loaded with several faulty assumptions, ubiquitous in other students’ comments. First, respondents tend to believe counselors force their clients to talk about issues when they do not wish to receive counsel, or that their sessions consist more of passive listening, where clients ramble as the counselor nods occasionally and interjects the expected empathetic reflection. Second, this respondent offhandedly equated counselors with psychologists, illuminating the lack of public awareness in deciphering services offered by counselors compared to psychologists.

Students indicated that the connotations afforded by common knowledge sources of professional counselors sometimes are positive and sometimes negative, depending on the source. Molly used media news as a concrete example: “Well, usually if they hear it in the news it will be negative, if the counselor screws up, they’ll hear that, and it might give them a bad image.” She continued that one negative news report could be potent enough to prevent her or others from ever seeking a professional counselor, regardless of the intensity of the personal need. Similarly, Kim thinks that movies could “go either way” and the audience “can either think of a positive image of counselors that they really do help someone, or they can portray them as people who are out of touch with reality and don’t really help the person necessarily.” This phenomenon follows the similar vein relative to the equivocal nature of these sources. Clearly, the common knowledge phenomenon affects the realm of professional counseling by impacting not only expectations of a session on the part of the counselor or the client, but also regarding the tendency to seek professional counseling services.

Discussion

We believe that due deliberation of our findings are warranted on two levels: macro and micro. On the macro level, professional organizations must become more aggressive in advocating for the profession in media and other “common knowledge sources.” Specifically, we interpret our results as a clarion call to the American Counseling Association (ACA), the American Mental Health Counselors Association (AMHCA), and the National Board for Certified Counselors (NBCC).

In the past decade, how many times has a major motion picture made central references to a Licensed Professional Counselor (LPC)? A systematic assessment in answering this important question is warranted elsewhere. However, the authors of the present article are unaware of a single time when this has occurred. We do recall, of course, main characters visiting psychiatrists, psychologists, social workers, and even marriage & family therapists. But, it is completely unacceptable for Hollywood to ignore licensed professional counselors.

Our findings suggest that movies are powerful sources by which the public come to generate their perceptions of professional counselors. When movies ignore the profession, then it follows that counselors become vulnerable to unhealthy stereotypes, negative perceptions, or simply empty perceptions. The role of professional counseling organizations is to advance the profession—and our data suggests that much more needs to be done in this domain.

To be more specific, every time a major motion picture is released where main characters interact with human service professionals that are not counselors—advocacy must occur. That is, leaders of ACA, AMHCA, NBCC, state counseling organizations, and others need to issue united statements of protest. Media such as the Associated Press need to pick up on these protests, carrying complaints of professional counselors’ lack of Hollywood notice.

To proactively accomplish this, the professional organizations must make permanent connections with producers, directors, writers, and other influential individuals in Hollywood as scripts are generated. Hollywood needs to be aware that if they ignore professional counselors as potential sources of human service provision, then the professional counseling organizations will become active. It should be worth their while to ensure that an apt, positive representation of counselors occurs.

On the micro level, individual counselors must be more active when advertising their services to the public. Specifically, the local media should be utilized to portray positive messages about professional counselors and benefits of service utilization. Local news media frequently look for short stories or opinions from human service professionals on various topics. This particularly is true around holidays or other special occasions—or even traumatic events—when media generate special interest stories. Local television specials can be powerful mediums for perception formation among families and potential clients. Universities with communication arts programs can budget monies for student and/or professionally generated DVDs that highlight and promote professional counselors as quality options during times of personal need.

The same advocacy can occur with school newspapers, web sites, circulars, and other sources of “common knowledge.” Respondents from the present study indicated that media is a powerful source and influences their perceptions. Professional counselors, therefore, should seize this medium—using it to generate reoccurring positive messages.

Respondents also told us that parental opinions, former clients, information from friends, and other word of mouth sources were important in how they came to think of professional counselors. There is little that counselors can do to encourage positive word of mouth advertising for professional counselors. However, they can utilize the media to its fullest.

On both macro and micro levels, we are concerned about professional counselors’ general tendencies towards passivity. That is, counselors presently are at the mercy of how happenstance may occur in clients’ lives to formulate perceptions of counselors. Rather, counselors should architect how they want potential clients to think about them. Draft the message and then market it through public service announcements, movies, the media, and other sources that consumers say are important to their concept formations. In short, be proactive rather than laissez-faire on this important matter.

Limitations and Future Research

We believe the present research study provided an apt representation of the students interviewed. However, as with all qualitative research, external validity is a limitation. That is, while replication is important for quantitative research (Cumming, 2005), qualitative research is particularly context dependent, relying on replication ultimately to prove its generalizability (Firmin, 2006b). In this light, we are limited in our ability to apply the present findings to all students at all universities in the United States or the public in general. Further research should replicate this study, assessing students and potential clients in varying parts of the country. Further, national survey data should be collected—providing more breadth to our present findings—although, of course, breadth and depth acquisitions tend to be methodological tradeoffs.

No minority representation was included in the present sample. Of course they were not deliberately excluded; rather, the general psychology class from which the sample was drawn contained only a few minority students. By random sample chance they were not included. As previously indicated, we used random sampling of the students in the study in order to enhance external validity as much as possible. The university from which the sample was taken contains only a 6% total minority population. Consequently, further research should be conducted in this area, possessing greater numbers of minority students in those samples. Also, replicating the present qualitative study with all minority students would provide an interesting comparison to the present findings from a Caucasian sample.

In sum, we believe that the present study has powerful heuristic value. Researchers should take this concept and develop it much further than what we were able to do in the present design. Assuming that professional counseling is going to develop and flourish in the upcoming decades, then the call we make for proactive advocacy must be heard. Students and the public have perceptions of professional counselors. That simply is a fact of human nature. It behooves the professional counselor leaders as well as individual counselors to craft what they wish those perceptions to be.

References

Atkinson, P., Coffey, A., & Delamont, S. (2003). Key themes in qualitative research. New York, NY: Rowman & Littlefield.
Bogdan, R. C., & Biklen, S. K. (2007). Qualitative research for education (5th ed.). Boston, MA: Allyn & Bacon.
Butterfield, P. J. (1989). The assessment of mental health professionals’ public image by means of multidimensional scaling. Digital Dissertations. (No. AAT 9019467)
Cope, C. (2004). Ensuring validity and reliability in phenomenological research using the analytical framework of a structure of analysis. Qualitative Research Journal, 4, 5­­–18.
Cumming, G. (2005). Understanding the average probability of replication: Comment on Killeen. Psychological Science, 16, 1002–1004.
Dahlem. G. G. (1969). Counselor image: Crucial target for research. Counselor Education and Supervision, 8, 130–135.
Daytner, K. (2006, June). Validity in qualitative research: Applications of safeguards. Paper presented at the 18th Annual Ethnographic & Qualitative Research in Education Conference, Cedarville, OH.
De Wet, J., & Erasmus, Z. (2005). Toward rigor in qualitative research. Qualitative Research Journal, 5, 27–40.
Dixon, N. D., Vrochopoulos, S., & Burton, J. (1997). Public image of counseling psychology: What introductory psychology textbooks say. The Counseling Psychologist, 25, 674–682.
Dotson-Blake, K., Know, D., & Holman, A. R. (2010). Reaching out: College student perceptions of counseling. Professional Issues in Counseling. Permanent on-line access http://www.shsu.edu/~piic/Fall2010.html
Erikson, E. (1963). Childhood and society (2nd ed.). New York, NY: Norton.
Fall, K. A., Levitov, J. E., Anderson, L., & Clay, H. (2005). African Americans’ Perception of Mental Health Professions. International Journal for the Advancement of Counseling, 27, 47–56.
Fall, K. A., Levitov, J. E., Jennings, M., & Eberts, S. (2000). The public perception of mental health professions: An empirical examination. Journal of Mental Health Counseling, 22, 123–134.
Firmin, M. (2006a). Using interview waves in qualitative research. In P. Brewer & M. Firmin (Eds.) Ethnographic and qualitative research in education (pp. 175–181). Newcastle, UK: Cambridge Scholars Press.
Firmin, M. (2006b, June). External validity in qualitative research. Paper presented at the 18th Annual Ethnographic and Qualitative Research in Education Conference, Cedarville, OH.
Firmin, M., Johnson, E., & Wikler, J. (2005, February). Professional human service occupation biases in general psychology textbooks. Paper presented at the 8th Annual Conference of the American Association of Behavioral and Social Sciences, Las Vegas, NV.
Flick, U. (2006). An introduction to qualitative research (3rd ed.). Thousand Oaks, CA: Sage.
Gay, L. R., Mills, G. E., & Airasian, P. (2009). Educational research (9th ed.). Upper Saddle River, NJ: Pearson.
Gelso, C. J., Brooks, L., & Karl, N. J. (1975). Perceptions of “counselors” and other helpers: A consumer analysis. Journal of College Student Personnel, 16, 287–292.
Gelso, C. J., & McKenzie, J. D. (1973). Effect of information on students’ perceptions of counseling and their willingness to seek help. Journal of Counseling Psychology, 20, 406–411.
Glaser, B. G. (1992). Basics of grounded theory analysis. Mill Valley, CA: Sociology Press.
Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory. Chicago, IL: Aldine.
Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18, 59–82.
King, J. H. (2006, July). Identity crisis and a uniform counseling title. Counseling Today, 17.
Lewins, A., & Silver, C. (2007). Using software in qualitative research: A step by step guide. Thousand Oaks, CA: Sage.
Lundberg, C. C., & Young, C. A. (2005). Modified grounded theory: How defensible is it? American Association of Behavioral and Social Sciences Journal, 8, 90–98.
Marshall, M. N. (1999). Improving quality in general practice: qualitative case study of barriers faced by health authorities. British Medical Journal, 219, 164–167.
Maxwell, J. A. (2005). Qualitative research design (2nd ed.). Thousand Oaks, CA: Sage.
McGuire, J. M., & Borowy, T. D. (1979). Attitudes toward mental health professionals. Professional Psychology, 10, 74–79.
Merriam, S. B. (2002). Assessing and evaluating qualitative research. In S. Merriam (Ed.).Qualitative research in practice (pp. 18–33). San Francisco, CA: Jossey-Bass.
Murstein, B. I., & Fontaine, P. A. (1993). The public’s knowledge about psychologist and other mental health professionals. American Psychologist, 48, 839–845.
Nunnally, J., & Kittross, J. M. (1958). Public attitudes toward mental health professions. American Psychologist, 13, 589–594.
Oliver, J. M., Reed, K. S., & Smith, B. W. (1998). Patterns of psychological problems in university undergraduates: Factor structure of symptoms of anxiety and depressions, physical symptoms, alcohol use, and eating problems. Social Behavior and Personality, 26, 211–232.
Patten, M. L. (1998). Questionnaire research: A practical guide. Los Angeles, CA: Pyrczak.
Ryan, G. W., & Bernard, H. R. (2003). Techniques to identify themes. Field Methods, 15, 85–109.
Richardson, P., & Handal, P. (1995). The public’s perception of psychotherapy and counseling: Differential views on the effectiveness of psychologists, psychiatrist, and other providers. Journal of Contemporary Psychotherapy, 25, 367–385.
Sarafino, E. P. (2005). Research methods: Using processes & procedures of science to understand behavior. Upper River Saddle, NJ: Prentice Hall.
Schindler, F., Berren, M. R., Hannah, T. M., Beigel, A., & Santiago, J. M. (1987). How the public perceives psychiatrists, psychologists, nonpsychiatric physicians, and members of the clergy. Professional Psychology: Research and Practice, 18, 371–376.
Seidman, I. (2006). Interviewing as qualitative research: A guide for researchers in education and the social sciences (3rd ed.). New York, NY: Teachers College, Columbia University.
Sharpley, C. F. (1986). Public perceptions of four mental health professions: A survey of knowledge and attitudes to psychologist, psychiatrists, social workers, and counselors. Australian Psychologist, 21, 57–67.
Sharpley, C. F., Bond, J. E., & Agnew, C. J. (2004). Why go to a counselor? Attitudes to, and knowledge of counseling in Australia, 2002. International Journal for the Advancement of Counseling, 26, 95–108.
Silverman, D. (2006). Interpreting qualitative data (3rd ed.). Thousand Oaks, CA: Sage.
Strauss, A. L., & Corbin, J. (2008). Basics of qualitative research: Grounded theory procedures and techniques (3rd ed.). Newbury Park, CA: Sage.
Tinsley, D. J., Hinson, J. A., Holt, M. S., & Tinsley, H. E. A. (1990). Level of psychosocial development, perceived level of psychological difficulty, counseling readiness, and expectations about counseling: Examination of group differences. Journal of Counseling Psychology, 37, 143–148.
Tse, L. M., Wantz, R. A., & Firmin, M. (2010). Perceptions of effectiveness among college students towards marriage and family counseling and therapy. The Family Journal. 18, 269–274. doi: 10.1177/1066480710371799.
Wantz, R. A., & Firmin, M. (2011). Perceptions of Professional Counselors: Survey of College Student Views. The Professional Counselor, 1, 71–81.
Wantz, R., Firmin, M., Johnson, C., & Firmin, R. (2006). University student perceptions of high school counselors. In M. Firmin and P. Brewer (Eds.), Ethnographic and qualitative research in education: Vol. 2. (pp. 171–184). New Castle, UK: Cambridge Scholars Press.

Michael W. Firmin is a Professor at Cedarville University. Richard A. Wantz is a Professor at Wright State University. Ruth L. Firmin and Courtney B. Johnson are doctoral students at Indiana University-Purdue University, Indianapolis. Correspondence can be addressed to Richard A. Wantz, Wright State University, Human Services, 3640 Colonel Glenn Highway, Dayton, OH 45435-0001, rick.wantz@right.edu.

The Effect of Parenthood Education on Self-Efficacy and Parent Effectiveness in an Alternative High School Student Population

Sep 7, 2014 | Article, Volume 1 - Issue 1

Becky Weller Meyer, Sachin Jain, Kathy Canfield-Davis

Adolescents defined as at-risk typically lack healthy models of parenting and receive no parenthood education prior to assuming the parenting role. Unless a proactive approach is implemented, the cyclic pattern of dysfunctional parenting— including higher rates of teen pregnancy, increased childhood abuse, low educational attainment, intergenerational poverty, and lack of steady employment—will continue. Parenthood education seeks to remediate this recurring cycle with at-risk youth before they become parents. Eighty-two alternative school students, grades 7 through 12, were randomly assigned to either an experimental or control group. After the experimental group completed a 16-session parenthood education program, differences between the two groups were tested using two measures: the Self-Efficacy Scale and the Parent Effectiveness Measure. Two-way ANOVA analyses showed statistical significance between the primary caregivers in the experimental and control group on the social self-efficacy and parent effectiveness measures. Implications and suggestions for further research are discussed.

Keywords: parenthood education, pre-pregnancy prevention, at-risk youth, social self-efficacy, parental effectiveness

At-risk adolescents typically lack the resources and background to build a strong foundation for parenthood. Often these adolescents do not have appropriate models of parenting, which potentially account for higher rates of teen pregnancies, higher incidences of childhood abuse or neglect, lack of self-efficacy, and low socio-economic status (Bifulco et al., 2002; Coleman & Karraker, 1997; Donenberg, Wilson, Emerson, & Bryant, 2002; Herrenkohl, Herrenkohl, & Egolf, 2003; Griffin, 1998; Helge, 1991, 1990; Herrenkohl, Herrenkohl, Rupert, Egolf, & Lutz, 1995; Massey, 1998; National Campaign to Prevent Teen Pregnancy [NCPTP], 2002; Shumow & Lomax, 2002). Without some type of intervention, at-risk adolescents may be prone to developing the same unhealthy patterns they experienced in their own upbringing and continue the cycle of poor parenting. Minet (1985) suggests parental patterns are reproduced across generations. For example, studies have found that 40% of mothers who were abused or neglected as children maltreated their own children, another 30% provided borderline care (Cowen, 2001), and over 22% of adolescent females that were born to a teenage mother will become teen parents themselves (Terry & Manlove, 2000). In the absence of more effective options, cyclic dysfunction may ensue. Education programs may provide a catalyst to learn positive parenting techniques and skills from sources outside one’s own upbringing (Reppucci, Britner, & Woolard, 1997) and to increase one’s sense of self-efficacy (Bandura, Adams, Hardy, & Howells, 1980; Griffith, 2002; Leerkes & Crockenberg, 2002). A program that enhances student self-efficacy may lead to increased motivation and a transfer of efficacious beliefs to other domains in participants’ lives (Bandura, 1982). This study examined the effect of a parenthood education program with at-risk alternative school adolescents on a measure of self-efficacy, parent effectiveness, and the parent-child relationship.

Cost to Society

Continuing the cycle of poor parenting comes with a great price tag to society. A host of societal problems—school failure, child abuse and neglect, substance abuse, assaultive behavior, intergenerational poverty, single mother births, welfare dependency, workforce underdevelopment, absent fathers and low self-efficacy—have all been shown to be closely associated with teen pregnancy (Herrenkohl et al., 2003; Massey, 1998; NCPTP, 2002). Financially, teen parenthood results in a considerable cost to local, state and national governments. The welfare costs for families started by a teen birth have been estimated at $25 billion in one year nationally (Herrenkohl, Herrenkohl, Egolf, & Russo, 1998), while almost 60% of the expenditures for another federal program, Aid to Families with Dependent Children (AFDC) go to single mothers who had their first child while a teenager (Dorrell, 1994). One cost benefit analysis suggests the government could increase spending on teen pregnancy prevention to eight times the current amount and still break even (Sawhill, 2001, 2007).

Although these figures are significant, the social-emotional burden is even more alarming. Without proper preparation to learn the skills needed for the challenges of childrearing, parents are highly likely to default to inappropriate coping mechanisms, such as violent behaviors. In the United States, 8,042 children are reported abused or neglected every day, more than 3.25 million annually; nearly four children die each day as a result of child abuse or neglect (Hopper, 2005; Massey, 1998). Education is an essential part of the foundation of our society; a violent or abusive environment undermines a student’s ability to learn and the damage is not easily repaired (Prothrow-Stith & Quaday, 1995; Swick & Williams, 2006). Clearly, the ongoing, multifaceted cost to society is difficult to calculate.

Although decline in teen pregnancy and birth rates recently exists (Flanigan, 2001), the United States still has the highest rates of teen pregnancy, teen births, and teen abortion in the fully industrialized world. There are nearly half a million teen births annually; each hour nearly 100 teen girls become pregnant and 55 give birth (U.S. Department of Health & Human Services, 2002; Ventura, Mathews, & Hamilton, 2002). Four in ten young women become pregnant at least once before age 20 and nearly 40% of these are age 17 or younger (NCPTP, 2002). The NCPTP (2005) reports 35% of teen girls become pregnant at least once as a teen—850,000 annually. Moreover, more teens are sexually active earlier. In a recent study (see Pearson, Muller, & Frisco, 2006; Terry & Manlove, 2000), 8.3% of students report having sex before age 13, a 15% increase since 1997. There was a 3% increase in teen pregnancy rates between 2005 and 2006 (NCPTP, 2011). If current fertility rates remain constant, the number of pregnancies and births among teenagers will increase 26% by 2010 (NCPTP, 2002). Collectively, the effects of teenage parenting have become a national crisis. Research, as well as politicians and national, state, and local initiatives and campaigns have embraced some aspect of the teen pregnancy agenda. In his 1995 State of the Union address, former President Bill Clinton declared teen pregnancy the most serious social problem facing the country.

Adolescent pregnancy continues to be a cycle of dependency and poverty. According to the U.S. Department of Commerce children of unmarried teenage mothers experience long-term abject poverty four times as often as children from other families (U.S. Department of Commerce, 1990) and two-thirds of families begun by young unmarried mothers are poor (NCPTP, 2002). Recent research found that unmarried teen mothers had a 43% lower income-to-need ratio, were 2.8 times more likely to be poor and 1.4 times more likely to receive government welfare benefits than were non-teen mothers or married teen mothers (Bissell, 2000). The NCPTP (2005) reports that 52% of all mothers on welfare had their first child as a teenager, and teen mothers are twice as likely to become dependent on welfare than their counterparts—nearly 80% of unmarried teen mothers are on welfare (Dorrell,1994).

Unremitting poverty is not the only issue of teenage parenthood; education and employment are affected as well. Less than 4 of 10 teen mothers who have a child before age 18 ever complete high school (Hotz, McElroy, & Sanders, 1997, 2005), with school dropouts six times more likely to become unmarried parents than their graduated counterparts (Dorrell, 1994). Moreover, about one-fourth of teenage mothers have a second child within 24 months of the first birth, which can further impede their ability to finish school, obtain or maintain a job, or escape poverty (Kalmuss & Namerow, 1994; Raneri & Wiemann, 2007). Without a high school diploma, the economic outlook is bleak: according to the 2003 U.S. Census Bureau, the median income for college graduates increased 13% in the past 25 years, while median income for high school dropouts decreased 30%. Teen mothers are more likely to work at low-paying jobs, experience longer periods of unemployment, receive welfare benefits, experience single parenthood, and live in high poverty compared to mothers who do not have a child in their teen years (Bissell, 2000). Even if a teen parent finishes high school, earnings are nearly 20% less annually than that of those completing some college courses, and at least 75% less annually than those who complete a bachelor’s degree—almost $1 million less in lifetime earnings (U.S. Census Bureau, 2003).

The Cycle Continues

If more children were born to parents who are ready and able to care for them, there would be a significant reduction in the social problems afflicting children—from school failure and crime to child abuse, neglect and poverty (NCPTP, 2002). The outcome for many children of teen parents is grim: children of teen mothers are 50% more likely to repeat a grade, less likely to complete high school, and perform lower on standardized tests than children born to older parents (NCPTP, 2002). One in five children in the U.S. lives with a mother who has not completed high school; the chances of that child dropping out of school are two to three times higher than those of a child whose mother has graduated (Dorrell, 1994). The sons of teen mothers are 13% more likely to end up in prison and the daughters of teen mothers are 22% more likely to become teen mothers themselves (Terry & Manlove, 2000). An adolescent single parent is the best single predictor that a child will live in poverty (Griffin, 1998).

A 2002 study by Johnson, Cohen, Kasen, Smailes, and Brook found maladaptive or adverse parental behavior (classified as hostile, abusive, or neglectful) significantly associated with subsequent disorders experienced by offspring, including anxiety, depression, substance abuse, and disruptive disorders. Abused or neglected children tend to perform poorly in school, lack the social skills that lead to inclusion in conventional peer groups, exhibit low self-esteem and experience increased levels of depression (Smith, 1996). According to a study sponsored by the National Institute of Justice (NIJ), abuse or neglect in childhood increases the likelihood of arrest as a juvenile by 53% (by 77% for females) and violent crime by 38% (“April is Child Abuse Prevention Month,” 2005). Another study found that disruptive behavior disorders in children are linked to negative parenting (Frick, Christian, & Wootton, 1999). As Prevatt (2003) concludes, these studies have consistently confirmed a direct correlation between parenting practices and developmental outcomes. The cycle is relentlessly repetitive.

When examining the childhood of teen parents, Herrenkohl et al. (1998) found that 96% of teen mothers and 97% of teen fathers had been abused or neglected as children, and a statistically significant number of teen parents were rated as lacking in self-confidence by their elementary school teacher. These adolescents exhibit a passive acceptance of their future and seem to believe nothing will change, despite their best efforts to the contrary (Griffin, 1998). This recurring cycle creates an overwhelming sense of hopelessness that can appear insurmountable to at-risk adolescents lacking in healthy supports and skills. Instead of reacting to the interminable products of this complex social problem, a proactive, preventive approach to intervention, which is both logical and cost-effective, may provide an enduring solution.

Parenthood Education Programs

Program rationale. In order to decrease the likelihood of teen pregnancy, increase self-efficacy, stop the cycle of childhood abuse, increase high school retention, improve the outlook of long-term employment, and increase parent effectiveness, a creative prevention program is necessary. One such approach is to integrate a proactive parenthood education program into the school curriculum to provide adolescents with focused educational intervention before they become parents. The public school systems are natural catchment areas, bringing together the majority of children and adolescents residing in a given community in a learning environment where didactic teaching is expected (Herz, Goldberg, & Reis, 1984). There is support for integrating programs that prepare “the next generation of parents” and recommendations from prior research have included adapting programs for inclusion in the school curriculum (Bissell, 2000; Cutting & Tammi, 1999; Dorrell, 1994; Griffith, 2002; Helge, 1989, 1991; Herz, Goldberg, & Reis, 1984; Jacobson, 2001; Rutgers, The State University, 1979; Stanberry & Stanberry, 1994; Stirtzinger et al., 2002).

Program description. A parenthood education program is comprised of a pre-service intervention through which adolescents are provided fundamental information regarding the role of “parent”—the skills, responsibilities, and time commitment required of a healthy functioning parent, appropriate parenting models, and positive, strength-focused parenting strategies. An effective parenthood education program repairs and reconstructs the lens through which at-risk adolescents see the parenting role, one that has typically been adversely impacted by their dysfunctional models. The adolescent is enabled to prepare more realistically for eventual parenting responsibilities and build a more effective relationship with their current parent/caregiver (Cutting & Tammi, 1999). Parenthood education aims to equip students with the skills necessary to make informed choices and a greater awareness of the responsibilities and implications of becoming a parent.

Prior programs. Relatively scant empirical literature exists on proactive parenthood education programs. A thorough review of the literature produced studies with three different types of programs. One study involving 7th and 8th grade students (ages 11–15) in two inner-city Chicago schools observed positive changes from pretest to posttest in the experimental group. The study measured the impact of a family life education program, for which the goals were twofold: reducing the risk of pregnancy by helping young teens develop a positive self-image, and promoting responsible sexual and contraceptive decision making. Program participants exhibited “(a) improved knowledge about contraception, reproductive physiology, and adolescent pregnancy outcomes; (b) increased awareness of the existence of specific birth control methods; (c) among seventh graders, more conservative attitudes toward circumstances under which sexual intercourse was viewed as personally acceptable, and among eighth graders, a shift toward more liberal attitudes; and (d) a greater tendency to acknowledge mutual responsibility for contraception” (Herz, Goldberg, & Reis, 1984, p. 309).

A second parenthood education program was developed as part of Save the Children, Scotland’s 3-year Positive Parenting Project in Angus, a rural school in North East Scotland. The participants were ages 13–14, labeled Year 2 level in Scotland. Goals were: increase the quality of life for the next generation of families; improve the way young people handle life within their own families; help develop young people’s communication skills in all their relationships; and establish good parenting as the foundation for other aspects of personal and social education (i.e., drug awareness, environmental education, and community involvement). Although not an experimental study, the conclusion was that the program had a positive impact on students by helping them think more objectively about the parenting role and concurrent responsibilities of parenthood (Cutting & Tammi, 1999).

A third study examined the longitudinal effects of an Adolescent Development Program on participants in Trinidad, Spain, 10 years after participation. The 3-month program was designed to develop the social and academic skills of adolescents ages 16 to 19, and focused on self-understanding, parenting skills, overcoming everyday problems, and increasing motivation to better equip themselves with marketable skills. Qualitative findings, gathered through follow-up surveys, indicated participants benefited from the program in several ways: they became better parents, improved communication with their own parents, developed higher levels of self-esteem, and female participants postponed childbearing (Griffith, 2002). While these studies have been important in showing that parenthood education programs can be influential with adolescents, there is a gap in experimental research with the at-risk high school population in the U.S.

An alternative school population. This study was designed to expand the body of knowledge and address the identified gap in current literature by quantifying the results of a parenthood education program with one of the more needy populations—pre-pregnancy, pre-parenting alternative school students. Research is plentiful on parenting education programs geared toward teen parents, a necessary, albeit reactionary course of action. Alternately, this study implemented a parenthood education program with alternative school students prior to parenthood. Alternative school adolescents are plagued with countless obstacles—low self-efficacy, substance abuse, poverty, child abuse, school failure, employment barriers, teen pregnancy—as a result of recurring intergenerational cycles (Barr & Parrett, 2003; Payne, 2003). Without proactive intervention, the cycle is bound to continue indefinitely and outlook for improvement is dim. These challenges were addressed in this study by exploring the following research questions: Would a parenthood education program integrated into an alternative school curriculum produce student participants who (a) demonstrate higher self-efficacy, (b) believe they are more prepared to be effective parents, and (c) evidence increased empathy for their current parent/caregiver, thereby improving the student’s appreciation for the parent-child relationship?

Methodology

Participants
The participants for this study were 82 students, grades 7th through 12th (M = 9.93, SD = 1.44), from an alternative school located in a rural community of a northwest state. Participants included 37 females and 45 males ranging from 13 to 20 years of age (M = 15.73, SD = 1.66). Sixty-five of the participants (79%) came from a home with a female primary caregiver, while 17 (21%) were from a family with a male primary caregiver. Additionally, 50 (61%) had a one-parent family, 27 (33%) had a two-parent family, and five (6%) were not living with a parent. The breakdown of the demographic characteristics by experimental and control group are displayed below.

Because the school is small (currently 100 students), the entire student population, except for pregnant or parenting teens, was utilized as a census sample. Therefore, no sampling procedures were enacted through the process. Four participants from the experimental group dropped out of the study. One male, grade 9, age 17, dropped out of school to get his GED; another male, grade 12, age 18, and the two female participants, both grade 12 and age 18, dropped out of school to seek full-time employment.

Instruments/Materials

Self-Efficacy Scale. The instrument used to measure self-efficacy was the Self-Efficacy Scale (Sherer et al., 1982). According to Bandura (1997), expectations of self-efficacy are the most powerful determinants of behavioral change because self-efficacy expectancies determine the initial decision to perform a behavior, the effort expended, and persistence in the face of adversity. According to Sherer, the primary author of the instrument, the goal in developing this instrument was to create a measure of self-efficacy that would not be tied to a specific situation or behavior. The purpose of this study was discussed with Sherer (personal communication, August 10, 2004), who agreed this instrument would be appropriate to measure a growth factor in the self-efficacy domain for this student population. The Self-Efficacy Scale is a 30-item measure assessing two self-efficacy constructs: general self-efficacy and social self-efficacy. The total scores for each subscale were utilized.

Parent Effectiveness Measure. Parent effectiveness, the second variable, was assessed with an adapted version of the Parenting Self-Agency Measure (Dumka et al., 1996). The 10-item instrument was measured on the same scale, but the items were modified to account for the fact that the student participants are not yet parents. The wording of items was changed to future tense to validate the change of context (e.g., “I feel sure of myself as a mother/father” was modified to “I will feel sure of myself as a mother/father”). Dumka (personal communication, October 6, 2004), the primary author of this measure, agreed that the instrument would be equally valid when adapted as a prospective parenting assessment, even though it was originally developed for use with parents of young teens. Dumka et al. noted that hypothetically, increased parenting self-agency should be one outcome of any preventive or therapeutic parenting intervention.

Procedure

Student participants were randomly assigned to either the experimental or the control group, initially 43 in each group. In order to study the effect of parenthood education with only non-pregnant, non-parenting alternative school students, this study was delimited to participants who fit this criteria—students who were either pregnant or already a parent were not included in the initial randomization of students to experimental or control groups. The experimental group attended the parenthood education program two mornings each week, for eight weeks. The control group was offered the opportunity to attend the same parenthood education course after the post data collection. A survey of parent education research revealed a range in curricula length, with the mean program at 10.5 weeks of instruction (Bamba, 2001; Cline & Fay, 1990; Cutting & Tammi, 1999; Doetsch, 1990; Fay, Cline, & Fay, 2000; Herz, 1984; Stirtzinger et al., 2002).

The parenthood education program was designed as a pre-pregnancy prevention strategy to teach pro-social parenting skills, a realistic picture of child raising (including financial, time, and emotional demands), child development, goal setting, proactive family planning strategies, and included learning opportunities for the development of self-efficacy and empathy (with current parent/caregiver roles and responsibilities). The program is partially a derivative of an established parenting program, which was read and approved by Dr. Foster Cline, a renowned child psychiatrist and parenting educator/author (personal communication, November 2004). Based upon extensive experience and certification, the first author was selected as the instructor for the program. The teaching method consisted of lectures, small and large group discussions, daily journaling, instructional videos, role-playing, practical and relevant information dissemination, and question and answer periods.

Results

The program impact for the results of the two instruments described above was assessed using a between-subjects posttest design. The experimental group concluded the last program session by completing the four instruments while the control group participants simultaneously finished the instruments in their advisory classes. The classroom teachers adhered to the posttest protocol discussed by the first author prior to testing (test environment, order of instruments, student question guidelines, timeline, data collection). It should be noted that the experimental group was much larger (n=39) and the testing environment was considerably louder and less focused than control group settings, where the participants in each room ranged from only two to six students and the rooms were observed to be quiet and composed. The experimental group was reported to be “in a hurry to finish” and “distracted,” with “excessive talking and chitchat” present in the room. It was expected that these factors might negatively influence the validity of the instrument results.

Table 2 summarizes the descriptive data—means and standard deviations of the scores—for each dependent variable with both the experimental and control group. The alpha level was set at .05 throughout the study, unless otherwise indicated.

General Self-Efficacy (GSE). Two-way ANOVA analyses were conducted to evaluate the effects of a participant’s group (experimental or control) and identified attributes (grade, age, gender, gender of primary caregiver and number of parents in the household) on general self-efficacy. Statistical significance was shown in the difference between the experimental and control group when averaged across the primary caregiver levels (male or female), F (1, 78) = 5.51, p < .05, partial η² = .07. No other main effect or any interaction effects were found to be significant on the GSE measure (see Table 3).

Social Self-Efficacy (SSE). The results for the two-way ANOVA on social self-efficacy indicated two statistically significant main effects. The primary caregiver factor, averaged across the grouping factor (experimental or control) was found to be significant at the alpha level .001, F (1, 78) = 11.24, p < .001, partial η² = .13 (see Table 4). The second main effect showing significance was the number of parents in the household (1, 2, or none), F (2, 76) = 3.51, p < .05, partial
η² = .08 (see Table 5).

Parent Effectiveness (PE). The two-way ANOVA analyses were again conducted to evaluate the effects of a participant’s group and attributes (grade, age, gender, gender of primary caregiver, and number of parents in the household) on a dependent measure, parent effectiveness. Statistically significant results were indicated in the grouping main effect (experimental or control), F (1, 78) = 5.03, p < .05, partial η² = .06, although in the opposite direction than originally hypothesized. The other main effect, parent effectiveness, and the interaction effect did not produce statistically significant results (see Table 6).

Discussion and Implications

The purpose of this study was to examine the effect of parenthood education on self-efficacy and parent effectiveness. Review of research studies corroborates that at-risk students are confronted with discouraging cyclic patterns including school failure, child abuse and neglect, substance abuse, poverty, out-of-wedlock births, welfare dependency, workforce underdevelopment, fatherless children and low self-efficacy (Herrenkohl et al., 2003; Massey, 1998; NCPTP, 2002). These intergenerational cycles of unconstructive parenting patterns will continue, absent new knowledge and more effective options. The current inquiry offered a proactive approach to teaching fundamental information through an integrated parenthood education program.

Using a two-way ANOVA, statistically significant results were obtained from four main effect analyses: (1) General Self-Efficacy measure (group by gender of primary caregiver); (2) Social Self-Efficacy measure (gender of primary caregiver); (3) Social Self-efficacy measure (group by number of parents in the household); and (4) Parent Effectiveness (group). Interestingly, the Parent Effectiveness measure actually produced results counter to the purported outcome.

The seemingly contradictory results from a comparison of overall means obtained on the Parent Effectiveness measure (the control group mean calculated higher than the experimental group) are a logical outcome when considering one of the goals of the parenthood education program—to increase student awareness of the financial, social-emotional and time demands of actual parenting. Once the experimental group became cognizant of the realistic depiction of parenting, it is probable they were evaluating themselves more accurately in the parental role, unlike the control group who idealistically, albeit erroneously, rated themselves as more “effective” parents based upon a limited, narrow definition of parenthood. These naïvely confident students, as Hess, Teti, and Hussey-Gardner (2004) contend, may feel highly secure at parenting tasks and believe they are a competent parent, but when they are working from a faulty knowledge base of what is developmentally appropriate, the self-analysis of parenting skills will not be a genuine reflection of ability. Hence, the experimental group’s authentic assessment was lower because it was filtered through the newfound knowledge of what it actually takes to be a healthy functioning parent. Cutting and Tammi (1999) documented a significant impact on participants’ perceptions of parenting after the parenthood education program in their Scotland study; students rated “Made me a lot more aware about what being a parent involves” higher than other survey choices. Similar to Griffith’s 2002 study, which found that the intervention enhanced the participants’ future parenting skills, these study results suggest a new awareness level of participants. Although contrary to the intention of this research, the outcome may be considered positive because there is a possibility students are now more prepared for parenthood and may be more cautious and introspective about pregnancy and family planning. Consistent with the Trinidad Spain study’s long-term follow up (Griffith), future studies should include subsequent analysis of pregnancy rates at various time intervals after program intervention to determine the program’s childbearing effects and capacity to deter teen pregnancy.

These findings are consistent with Bandura’s 1982 theory that a program which aims to enhance self-efficacy will lead to increased motivation and a transfer of efficacious beliefs to other domains in participants’ lives. The intervention program provided a mechanism for student participants to gain new knowledge and attitudes from a source outside their own family construct and to increase their own sense of self-efficacy (Hess et al., 2004; Leerkes & Crockenberg, 2002; Reppucci, Britner, & Woolard, 1997). A supposition can be made that knowledge and new insight from the intervention program led to an increase of general self-efficacy for student participants, which subsequently translated into enhanced scores on the post-test measures. This would support Bandura’s theory of efficacy transference. Integrating parenthood education into an alternative school curriculum affords at-risk students the opportunity for exposure to healthy parenting and family planning information that they would not otherwise receive. By participating in a parenthood education program designed as a pre-pregnancy prevention strategy, alternative school students receive instruction and guidance in prosocial parenting skills, realistic child raising (including financial, time, and emotional demands), child development, proactive family planning, goal setting, and the development of self-efficacy and empathy (with parent/caregiver’s roles and responsibilities).

Limitations

The major limitation of this study was using the program with the entire experimental group (39 students) placed in one large instructional setting. Although logistically necessary for the school’s academic and scheduling requirements, this arrangement was not theoretically sound from an alternative school educational pedagogy (Barr & Parrett, 2003). A group of 39 students is too many to monitor, focus toward lesson goals and objectives, and authentically involve in discussions and activities. It is likely that sustainability of program content for student participants was weak or even lost due to the size of the group. A smaller group would naturally prompt an increase in instructor-student interaction, group discussion participation, and greater retention of the information by student participants. Future programs or follow-up studies are recommended to be not more than 8–12 students per class session, which is consistent with group theory and at-risk curriculum recommendations (Corey, 1990; Becvar, Canfield, & Becvar, 1997).

The duration of the program—eight weeks, two times per week—can be a limitation. Although the length of the parenthood education program is consistent with best practices and the average for parent education programs (Bamba, 2001; Cline & Fay, 1990; Cutting & Tammi, 1999; Doetsch, 1990; Fay, Cline, & Fay, 2000; Herz, 1984; Stirtzinger et al., 2002), extending the program would allow for reiteration of material, increased process and reflection time, and retention of curriculum. Because the program content is unfamiliar to this population, a longer time span for program intervention would assist in assimilation and application for the students.

Generalizability of the study findings beyond this population is limited. Because the population consisted of only one alternative school in Northern Idaho, caution is advised in generalizing the results to other settings. In order to extend generalizability, future research should replicate the current study parameters in similar populations.

Recommendations for future studies include: (1) increased integration of the program across a full semester scheduled to meet at least one hour per week; (2) implementation of the program with group sizes which are theoretically sound for the at-risk adolescent population (between 8–12 students per group); (3) administration of posttests in at least two sessions versus all assessments completed in only one session; (4) the addition of a qualitative component to the posttest measures which would enhance understanding of the at-risk adolescent; and, (5) inclusion of a follow-up measure that would help analyze pregnancy rates at various time intervals after program intervention to determine the effect of the program in deterring teen pregnancy over time. These recommendations would serve to alleviate the current study’s limitations, expound on its strengths, and produce a robust, credible parenthood education program effective with our at-risk alternative school adolescents.

References

April is Child Abuse Prevention Month. (2005, March). Bonner County Daily Bee, 4, 13.
Bamba, M. L. (2001). Evaluating the impact of parent education for parents of young children (Doctoral dissertation, University of Oregon, 2001). Dissertation Abstracts International, 61 (7-A), 2586.
Bandura, A. (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, 122–147.
Bandura, A. (1997). Self-efficacy: The exercise of control. New York, NY: W. H. Freeman.
Bandura, A., Adams, N., Hardy, A., & Howells, G. (1980). Tests of the generality of self- efficacy theory. Cognitive Therapy and Research, 3, 39–66.
Barr, R. D., & Parrett, W. H. (2003). Saving our students, saving our schools: 50 proven strategies for revitalizing at-risk students and low-performing schools. Glenview, IL: Pearson Skylight.
Becvar, R. J., Canfield, B. S., & Becvar, D. S. (1997). Group work: Cybernetic, constructivist, and social constructionist perspectives. Denver, CO: Love Publishing.
Bifulco, A., Moran, P. M., Ball, C., Jacobs, C., Baines, R., & Bunn, A., & Cavagin J (2002). Childhood adversity, parental vulnerability and disorder: Examining inter-generational transmission of risk. Journal of Child Psychology and Psychiatry, 43, 1075–1086.
Bissell, M. (2000). Socio-economic outcomes of teen pregnancy and parenthood: A review of the literature. Canadian Journal of Human Sexuality, 9, 191–204.
Cline, F., & Fay, J. (1990). Parenting with love and logic: Teaching children responsibility. Colorado Springs: Pinon Press.
Coleman, P. K., & Karraker, K. H. (1997). Self-efficacy and parenting quality: Findings and future applications. Developmental Review, 18, 47–85.
Cowen, P. S. (2001). Effectiveness of a parent education intervention for at-risk families. Journal of the Society of Pediatric Nurses, 6, 73–82.
Cutting, E., & Tammi, L. (1999). Understanding parents, understanding parenthood: An education for parenthood course piloted at Monifeith High School, Angus (Report No. PS028153). United Kingdom, Scotland: Save the Children Scotland, Edinburgh. (ERIC Document Reproduction Service No. ED 437 181).
Doetsch, P. (1990). Reducing the risk for child abuse by developing and implementing a parenting program for teenage mothers (Report No. CG-022-668). Nova University, FL: Counseling and Student Services Clearinghouse. (ERIC Document Reproduction Service No. ED321218).
Donenberg, G. R., Wilson, H. W., Emerson, E., & Bryant, F. B. (2002). Holding the line with a watchful eye: The impact of perceived parental permissiveness and parental monitoring on risky sexual behavior among adolescents in psychiatric care. AIDS Education and Prevention, 14, 138–157.
Dorrell, L. D. (1994). A future at risk: Children having children. Clearing House, 67, 224–227.
Dumka, L. E., Stoerzinger, H. D., Jackson, K. M., & Roosaa, M. W. (1996). Examination of the cross-cultural and cross-language equivalence of the Parenting Self-Agency Measure. Family Relations, 45, 216–222.
Fay, J., Cline, F. W., & Fay, C. (2000). Becoming a love and logic parent: Parent handbook. Golden, CO: The Love and Logic Press.
Flanigan, C. (2001). What’s behind the good news: The decline of teen pregnancy rates during the 1990s. Washington, DC: National Campaign to Prevent Teen Pregnancy.
Frick, P. J., Christian, R. E., & Wootton, J. M. (1999). Age trends in the association between parenting practices and conduct problems. Behavior Modification, 23, 106–128.
Griffin, N. C. (1998). Cultivating self-efficacy in adolescent mothers: A collaborative approach. Professional School Counseling, 1, 53–59.
Griffith, J. (2002). To handle life’s challenges: A tracer study of Servol’s adolescent development programme in Trinidad. Early childhood development: Practice and reflections. Following footsteps (Report No. 16). The Hague, Netherlands: Bernard van Leer Foundation. (ERIC Document Reproduction Service No. ED 463 857).
Helge, D. (1989a). Preventing teenage pregnancies in rural America (Report No. CG-022-212). Bellingham, WA: National Rural and Small Schools Consortium. (ERIC Document Reproduction Service No. ED314677).
Helge, D. (1989b). Report of pilot project regarding strategies for enhancing self-esteem of at- risk students (Report No. CG-022-213). Bellingham, WA: Counseling and Student Services Clearinghouse. (ERIC Document Reproduction Service No. ED 314678).
Helge, D. (1989c). Rural “at-risk” students: Directions for policy and intervention (Report No. RC-017-663). Bellingham, WA: Rural Education and Small Schools Clearinghouse. (ERIC Document Reproduction Service No. ED 323046).
Helge, D. (1990). A national study regarding at-risk students (Report No. RC-017-778). Bellingham, WA: Rural Education and Small Schools Clearinghouse. (ERIC Document Reproduction Service No. ED 324178).
Helge, D. (1991). At-risk students—a national view of problems and service delivery strategies. Rural Special Education Quarterly, 10, 42–52.
Herrenkohl, E. C., Herrenkohl, R. C., & Egolf, B. P. (2003). The psychosocial consequences of living environment instability on maltreated children. American Journal of Orthopsychiatry, 73, 367–380.
Herrenkohl, E. C., Herrenkohl, R. C., Egolf, B. P., & Russo, M. J. (1998). The relationship between early maltreatment and teenage parenthood. Journal of Adolescence, 21, 291–303.
Herrenkohl, E. C., Herrenkohl, R. C., Rupert, L. J., Egolf, B. P., & Lutz, J. G. (1995). Risk factors for behavioral dysfunction: The relative impact of maltreatment, SES, physical health problems, cognitive ability, and quality of parent-child interaction. Child Abuse and Neglect, 19, 191–203.
Herz, E. J., Goldberg, W. A., & Reis, J. S. (1984). Family life education for young adolescents: A quasi-experiment. Journal of Youth and Adolescence, 13, 309–327.
Hess, C. R., Teti, D. M., & Hussey-Gardner, B. (2004). Self-efficacy and parenting of high-risk infants: The moderating role of parent knowledge of infant development. Applied Developmental Psychology, 25, 423–437.
Hopper, J. (2005). Child abuse: Statistics, research, and resources. Retrieved April 1, 2005, from http://www.jimhopper.com
Hotz,V. J., McElroy, S.W., & Sanders, S. G. (1997). The impacts of teenage childbearing on the mothers and the consequences of those impacts for government. In R. A. Maynard (Ed.). Kids having kids (pp. 55–94). Washington, DC: Urban Institute.
Hotz,V. J., McElroy, S. W., & Sanders, S. G. (2005). Teenage childbearing and its life cycle consequences: Exploiting a natural experiment. The Journal of Human Resources, 40(3), 683–715.
Jacobson, L. (2001). Program builds young students’ parenting skills. Education Week, 20 (39), 1–3.
Johnson, J. G., Cohen, P., Smailes, E. M., Kasen, S., & Brook, J. S. (2002). Television viewing and aggressive behavior during adolescence and adulthood [Electronic version]. Science, 295, 2468–2471.
Kalmuss, D. S., & Namerow, P. B. (1994). Subsequent childbearing among teenage mothers: The determinants of a closely spaced second birth. Family Planning Perspectives, 26, 149–159.
Leerkes, E. M., & Crockenberg, S. C. (2002). The development of maternal self-efficacy and its impact on maternal behavior. Infancy, 3, 227–247.
Massey, M. S. (1998). Early childhood violence prevention (Report No. EDO-PS-98-9). Champaign, IL: ERIC Clearinghouse on Elementary and Early Childhood Education. (ERIC Document Reproduction Service No. D424032).
Minet, S. B. (1985). An infant/toddler program for high risk parents and their children (Report No. PS-015-403). CA: Elementary and Early Childhood Education Clearinghouse. (ERIC Document Reproduction Service No. ED 261806).
National Campaign to Prevent Teen Pregnancy [NCPTP]. (2011). Teen birth rate increase 2006 Retrieved January 12, 2011, from http://www.thenationalcampaign.org/resources/pdf/TBRincrease_2006.pdf
National Campaign to Prevent Teen Pregnancy [NCPTP]. (2002). Not just another single issue: Teen pregnancy prevention’s link to other critical social issues (Report No. UD-034-831). Washington, DC: Author. (ERIC Document Reproduction Service No. ED462522).
National Campaign to Prevent Teen Pregnancy [NCPTP]. (2005). Retrieved March 12, 2005, from
http://www.teenpregnancy.org/Default.asp?bhcp=1
National Clearinghouse on Child Abuse and Neglect Information. (2004). What is child abuse and neglect? Retrieved March 12, 2005, from http://nccanch.acf.hhs.gov/pubs/factsheets/whatiscan.cfm
National Institute of Justice (NIJ). (2005). Retrieved April 4, 2005, from http://www.ojp.usdoj.gov/nij/
Payne, R. K. (2003). A Framework for understanding poverty (3rd Rev. ed.). Highlands, TX: aha! Process, Inc.
Pearson, J., Muller, C., & Frisco, M. L. (2006). Parental involvement, family structure, and adolescent sexual decision making. Sociological Perspectives, 49, 67–90.
Prevatt, F. F. (2003). The contribution of parenting practices in a risk and resiliency model of children’s adjustment [Electronic version]. British Journal of Developmental Psychology, 21, 469–480.
Prothrow-Stith, D., & Quaday, S. (1995). Hidden casualties: The relationship between violence and learning. Washington, DC: National Health & Education Consortium and National Consortium for African American Children, Inc. ED 390 552.
Raneri, L.G., & Wiemann, C.M. (2007). Social ecological predictors of repeat adolescent pregnancy. Perspectives on Sexual and Reproductive Health, 39(1) 39–47.
Reppucci, N. D., Britner, P. A., & Woolard, J. L. (1997). Preventing child abuse and neglect through parent education. Baltimore: Paul H. Brooks.
Rutgers, The State University. (1979). Education for Parenthood (Vocational-Technical Curriculum Lab Report No. CE047008). Abstract retrieved August 2, 2004, from Adult, Career, and Vocational Education Clearinghouse. (ERIC Document Reproduction Service No. ED 281048).
Sawhill, I.V. (2001). What can be done to reduce teen pregnancy and out-of-wedlock births? Center on Children and Families Briefs. Retrieved online on December 14, 2009 from http://www.brookings.edu/papers/2001/10childrenfamilies_sawhill.aspx
Sawhill, I.V. (2007) Attacking poverty and inequality: Reinvigorate the fight for greater opportunity. Center on Children and Families Briefs. Retrieved online on December 14, 2009 from http://www.brookings.edu/papers/2007/0228poverty_haskins_Opp08.aspx
Sherer, M., Maddux, J. E., Mercandante, B., Prentice-Dunn, S., Jacobs, B., & Rogers, R. W. (1982). The self-efficacy scale: Construction and validation. Psychological Reports, 51, 663–671.
Shumow, L., & Lomax, R. (2002). Parental efficacy: Predictor of parenting behavior and adolescent outcomes. Parenting: Science and Practice, 2, 127–150.
Smith, C. (1996). The link between childhood maltreatment and teenage pregnancy. Social Work Research, 20, 131–141.
Stanberry, J. P., & Stanberry, A. M. (1994). Confidence in parenting: Is parent education working? (Report No. PS-023-082). Mississippi: Elementary and Early Childhood Education Clearinghouse. (ERIC Document Reproduction Service No. ED382324).
Stirtzinger, R., McDermid, S., Grusec, J., Bernardini, S., Quinlan, K., & Marshall, M. (2002). Interrupting the inter-generational cycle in high-risk adolescent pregnancy. The Journal of Primary Prevention, 23, 7–22.
Swick, K. J., & Williams, R. D. (2006). An analysis of Bronfenbrenner’s bio-ecological perspective for early childhood educators: Implications for working with families experiencing stress. Early Childhood Education Journal, 33(5) 371–378.
Terry, E., & Manlove, J. (2000). Trends in sexual activity and contraceptive use among Teens. Washington, DC: National Campaign to Prevent Teen Pregnancy.
United States Census Bureau. (2003). Current population survey, 2003 annual social and economic supplement. Retrieved March 31, 2005, from http://www.census.gov/hhes/www/income.html
U.S. Department of Commerce, Bureau of Census. 1990. Current population reports: Money income and poverty status in the United States. Washington, D.C.: U.S. Government Printing Office.
United States Department of Health & Human Services. (2002). Teen births. Retrieved from http://www.cdc.gov/nchs/fastats/teenbrth.htm
Ventura, S. J, Mathews, T. J., & Hamilton, B. E. (2002). Teenage births in the United States: State trends, 1991–2000, an update. National vital statistics reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 50(9), 1–4.

Becky Weller Meyer is Principal of Sandpoint High School in Sandpoint, Idaho. Sachin Jain, NCC is Assistant Professor of Counseling and School Psychology at the University of Idaho. Kathy Canfield-Davis is Assistant Professor of Educational Leadership at the University of Idaho. Correspondence can be addressed to Sachin Jain, University of Idaho, 1031 N. Academic Way, Coeur d’Alene, ID 83814 -2277, sjain@uidho.edu.

The Impact of Internalized Homophobia on Outness for Lesbian, Gay, and Bisexual Individuals

Sep 6, 2014 | Article, Volume 1 - Issue 3

Genevieve Weber-Gilmore, Sage Rose, Rebecca Rubinstein

Internalized homophobia, or the acceptance of society’s homophobic and antigay attitudes, has been shown to impact the coming out process for LGB individuals. The current study examined the relationship between levels of outness to family, friends and colleagues and internalized homophobia for 291 lesbian, gay, and bisexual individuals. Results suggest internalized homophobia is a predictor of outness to friends, colleagues, and extended family, but not nuclear family. A discussion of these findings as well as implications for counselors are provided.

Keywords: internalized homophobia, “coming out,” lesbian, gay, bisexual

Lesbian, gay and bisexual individuals (LGB) have been shown to be one of the most stressed population groups in society (Iwasaki & Ristock, 2007). Beyond dealing with daily stressors common with their heterosexual counterparts, LGB individuals experience unique stressors such as homophobia, societal discrimination and limited social and institutional supports due to their same-gender sexual orientations. Homophobia is defined as the anxiety, aversion, and discomfort that some individuals experience in response to being around, or thinking about LGB behavior or people (Davies, 1996; Spencer, & Patrick, 2009).

Homophobia is endorsed through the perpetuation of negative stereotypes about LGB behavior and people on both societal and individual levels, and the discrimination and prejudice of LGB people across the lifespan (Bobbe, 2002; Davies, 1996; Spencer & Patrick, 2009). Subtle forms of homophobia and discrimination such as the exclusion of LGB couples in the media and blatant acts of alienation experienced when individuals refuse to rent to LGB people are far too common in the lives of LGB individuals (Neisen, 1990; Smiley, 1997). Other examples of homophobia include unfair treatment by family, friends, and peers; loss of employment or lack of promotions; and observing/hearing people making anti-gay jokes (King, Reilly, & Hebl, 2008; Rankin, Weber, Blumenfeld, & Frazer, 2010). These homophobic events greatly affect the lives of LGB individuals such that many LGB individuals hide their sexual orientation from others and feel shame and other negative feelings towards themselves (Center for Substance Abuse Treatment [CSAT], 2001).

Higher levels of stress are common among LGB individuals who feel they have to hide their sexual orientation from others (Iwasaki & Ristock, 2007) or have negative feelings towards themselves based on their same-gender sexual attractions (Weber, 2008). The acceptance of society’s homophobic and anti-gay attitudes about LGB sexual orientations is known as internalized homophobia. Low self-esteem and low self-acceptance; shame; guilt; depression and anxiety; feelings of inadequacy and rejection; verbal and physical abuse by family, partners, and/or peers; homelessness; prostitution; substance use and abuse; and suicide are some of the common feelings or behaviors that are associated with internalized homophobia (CSAT, 2001; Diamond & Wilsnack, 1978; Grossman, 1996; Lewis, Saghir, & Robins, 1982; Ross & Rosser, 1996; Saghir & Robins, 1973; Spencer, & Patrick, 2009; Stall & Wiley, 1988; Stein & Cabaj, 1996). According to Bobbe (2002), the negative feelings and behaviors associated with internalized homophobia can have a more painful and disruptive influence on the health of LGB individuals than external, overt forms of oppression such as prejudice and discrimination.

Homophobia and internalized homophobia have been shown to impact the coming out process for LGB individuals. “Coming out” is a shortened term for “coming out of the closet” (Hunter, 2007, p. 41). As LGB individuals begin to disclose their sexual orientation to others, or “come out,” they often experience a series of stages that include but are not limited to an initial awareness of being different, grieving, feelings of inner conflict, and an established sexual minority identity with long-term relationships. This is a developmental process that involves a person’s awareness and acknowledgement of same-gender oriented thoughts and feelings while accepting being LGB as a positive stage of being (Browning, Reynolds, & Dworkin, 1991; Kus, 1990; McGregor et al., 2001; Ridge, Plummer, & Peasley, 2006). The process of forming an LGB identity or “coming out” is a challenging process as it involves adopting a non-traditional sexual identity, restructuring one’s self-concept, and changing one’s relationship with society (Reynolds & Hanjorgiris, 2000; Ridge, Plummer, & Peasley, 2006).

Coming out for bisexual individuals is a “more ambiguous status” (Hunter, 2007, p. 53) as it is complicated by marginalization from both the straight and gay communities. This marginalization usually includes same-gender oriented friends urging bisexual individuals to adopt a gay lifestyle and heterosexually-oriented friends pressuring them to conform to heterosexual standards (Smiley, 1997). Although it is common for research on bisexual individuals to be lumped with lesbians and gay men (Hoang, Holloway, & Mendoza, 2011), Knous (2005) proposed a series of steps that individuals who identify as bisexual might take in disclosing and ultimately embracing their sexual identity. The first step is to be attracted or to participate in sexual activity with someone of either gender. The second step is to become labeled as bisexual either by themselves or by society. The third step is to be participatory in the bisexual community through personal or group pride. Bisexual individuals still experience stigma similar to their lesbian, gay, or heterosexual counterparts (Knous, 2005), and respond in similar ways: they might “pass” as either gay or straight, an act intended to hide one’s same-gender attractions (Herek, 1996); disclose their bisexual identity; or join support groups to fight the stigma (Knous, 2005).

Multiple researchers have described average chronological ages at which experiences related to coming out occur, which were summarized by Hunter (2007). Lesbians and bisexual women first experience awareness of same-gender attraction between the ages of ten and eleven years; gay and bisexual males between the ages of nine and thirteen years. Gay male youths on average experience their first sexual experiences a few years later between the ages of thirteen and sixteen years, while lesbian youths experiment around twenty years of age. First disclosures of sexual orientation happen between the ages of sixteen and nineteen for lesbian youths, and sixteen and twenty for gay male youths. Regardless of the age of disclosure, negative responses to being lesbian, gay, or bisexual still occur, and this “tempers the motivation of persons…in terms of making disclosures” (Hunter, 2007, p. 84). This may explain the three main patterns of sexual identity in individuals who are moving towards identifying as gay, lesbian, or bisexual (Rosario, Schrimshaw, Hunter, & Braun, 2006). These patterns include consistently identifying as gay or lesbian, transitioning from bisexual to gay or lesbian, and consistently identifying as bisexual. Youths who were engaged in transitional identities continued to change their behavior and orientation to match their new identity. The process of acceptance of one’s sexual identity, committing to that identity, and integrating that identity into one’s life is something that does not end after adolescence, but continues into adulthood (Rosario, Schrimshaw, Hunter, & Braun, 2006).

The process of coming out could be a major source of stress for LGB individuals (Iwasaki & Ristock, 2007). Some disclosures could cause harm in the lives of LGB individuals such as family crisis, dismissal from the household, loss of custody of children, loss of friends, or mistreatment in the workplace (Hunter, 2007; Rotheram-Borus & Langabeer, 2001; Savin-Williams & Ream, 2003). Yet, not coming out to others means LGB individuals must maintain personal, emotional, and social distance from those to whom they remain closeted in order to “protect the secrecy” of their “core identity” (Brown, 1988, p. 67).

A number of studies have explored the unique challenges associated with the coming out process for LGB individuals. A study by Flowers and Buston (2001) investigated “passing” as heterosexual, or assuming the identity of a heterosexual individual while hiding behaviors associated with an LGBT identity. In their study, Flowers and Buston examined the retrospective accounts of gay identity development for 20 gay men. Living a lie was identified as a common theme in their interviews such that many men continued to assume a heterosexual identity as a response to a non-accepting homophobic society. This lie was not something that was simply stated; rather, it had to be created and maintained “all the time” (p. 58, Flowers & Buston), and only temporarily eased the participants’ feelings of isolation and identity confusion (Flowers & Buston). Shapiro, Rios, & Stewart (2010) support the findings of Flowers and Buston. In this study that explored narrative accounts of sexual minority identity development among lesbians, cultural norms that failed to acknowledge the existence of non-normative sexual identities were identified and discussed. Such neglect of LGB identities required personal silence on the part of the respondents, which helped them avoid the negative consequences of coming out such as feelings of danger and discomfort as well as punishment.

Paul and Frieden (2008) examined the process of integration of gay identity and self-acceptance among gay men. Participants described societal homophobia and heterosexism as “powerful barriers” to self-acceptance, and validation and acceptance from others as helpful supports in the acceptance of themselves. Respondents indicated that they felt emotional pain or crisis when they began to develop a same-gender sexual identity and received negative messages about that identity. They feared that loved ones would not be accepting, and often denied that they were gay, both to themselves and to others.

A study by Rowen and Malcolm (2002) examined internalized homophobia and its relationship to sexual minority identity formation, self-esteem, and self-concept among 86 gay men. Results indicated that higher levels of internalized homophobia were associated in less developed gay male identities. In addition, gay men who felt more uncomfortable with their sexual orientations were more likely to experience guilt over their same-gender sexual behavior. Internalized homophobia also was found to be related to lower levels of self-esteem and self-concept in terms of physical appearance and emotional stability.

There are a diverse range of personal variables such as “personality characteristics, overall psychological health, religious beliefs, and negative or traumatic experiences regarding one’s sexual orientation” (Hunter, 2007, p. 94) that impact to whom LGB individuals disclose their same-gender sexual orientation. Some same-gender oriented individuals are closeted entirely and hide their sexual orientations from others for fear of their reactions (Iwasaki & Ristock, 2007). Others will only come out to selected people (e.g., friends, family, colleagues, teachers, medical providers) rather than everyone at once. Several will come out completely and become very involved in the LGB community by attending LGB events and venues.

In general, disclosures are most often first made to friends of LGB people who are considered to be somewhat affirming of one’s same-gender sexual orientation (Hunter, 2007). According to Cain (1991), coming out to friends can bring two friends closer together, confirm an already close relationship, or cause a strain between previously close friends. Results from a study by D’Augelli and Hershberger (2002) revealed that 73% of lesbian and gay youths first told a friend about their same-gender sexual attractions. Other research suggested that bisexual men and women are also more likely to disclose to their friends than to family members and work colleagues (Hunter, 2007). These friends are usually across sexual identities and often with individuals who are heterosexual, and less with other bisexuals (Galupo, 2006).

Regardless of the outcome, the notion that disclosure to friends differs from disclosure to family members allows for LGB individuals to “select friends who are supportive or drop those unlikely to accept the revelation, something they cannot do in their parental or sibling relationships” (Cain, 1991, p. 349). LGB individuals do not always disclose their LGB sexual orientations to family members for fear of consequences such as “…anything from a dismissal of their feelings to an actual dismissal from the household” (Rotheram-Borus & Langabeer, 2001, p. 104). Disclosures to parents elicit much anxiety for LGB individuals as there are limited ways to predict how parents will respond (Hunter, 2007). Many LGB individuals fear losing familial support after disclosing to family members (Carpineto et. al, 2008; D’Augelli, Grossman, & Starks, 2005). According to Shapiro, Rios, & Stewart (2010), when LGB individuals have identified the family as a source of conflict, these individuals considered their parental figures to be unsupportive of their sexual identity. This conflict leads to an increase in tension within the family. According to Savin-Williams and Ream (2003), 90% of college men reported that coming out to their parents was a “somewhat” to “extremely” challenging event for them (p. 429).

Siblings have been described as more accepting of their LGB sibling’s disclosure, and if there is rejection it is usually less stressful than rejection by the parents (Cain, 1991). Lesbian wives do not often disclose to their husbands for fear of consequences (i.e., violence, custody battles), but men who come out as bisexual following their marriage to a woman tell her soon after he accepts his bisexual identity (Hunter, 2007). No data on gay men and their disclosure to their wives could be located. It also is not uncommon for LGB parents to keep their same-gender sexual orientations from their children for fear of losing custody or inflicting harm on their children (Hunter, 2007).

There are positives and negatives to coming out at work and to work colleagues (Hunter, 2007), and therefore there are varying levels of disclosure among LGB individuals. Research suggests that LGB individuals who are more open at work experience higher levels of job satisfaction and commitment to the workplace (Day & Shoenrade, 1997; Griffith & Hebl, 2002; King, Reilly, & Hebl, 2008). Some LGB individuals may feel “honest, empowered and connected” after disclosure at work, and able to speak more freely about their personal lives and romantic relationships (Hunter, 2007, p. 127). Organizations that have written non-discrimination policies, are actively affirmative, and offer trainings that incorporate LGB issues usually impact whether lesbian and gay individuals come out in the workplace (Griffith & Hebl, 2002). It is unfortunate, however, that there is little legal protection for LGB individuals based on sexual orientation in most workplaces (Hunter, 2007). The possible harm (i.e., ridicule, ostracism, job loss) of disclosing at work without legal protection, and in some cases even with legal protection, causes many LGB individuals to stay closeted at work. Although keeping one’s LGB sexual orientation a secret might create fewer problems with regard to stigma, discrimination, and discreditability, living “a double life” can be personally and professionally “costly” (Hunter, 2007, p. 126). Hunter further summarized the limited professional literature on outness in the workplace and reported that more than two-thirds of lesbian and gay individuals think coming out in the workplace would create problems and challenges for them, while one-third believed disclosure would hurt their career progression (i.e., not being hired, not being promoted, not receiving personal or professional support). Fears of and personal experiences with harassment and heterosexism in the workplace also could negatively impact one’s psychological and physical well-being and thus one’s decision to disclose to work colleagues.

A major study based on the utilization of The National Lesbian Health Care Survey (NLHCS; Bradford, Ryan, & Rothblum, 1993) examined the degrees of outness and to whom disclosures were made for a national sample of 1,925 lesbians. The results of this study support the aforementioned identification of whom LGB individuals come out to more often as they move through the process of forming a sexual minority identity. Researchers found that although the majority of lesbians (88%) were out to all gay and lesbian individuals who they knew, much smaller numbers were out to all family members (27%), heterosexual friends (28%), and co-workers (17%). Furthermore, many participants reported not coming out to any family members (19%) or co-workers (29%). Correlations between degree of outness and fears as a lesbian were also analyzed and results showed a negative relationship such that lesbians who were less out to family, heterosexual friends, and co-workers had more fear of exposure as a lesbian. Correlations were strongest among outness to heterosexual friends and co-workers. No other studies that specifically examined the relationship between level of outness and internalized homophobia could be located. Therefore, this important relationship remains underexplored.

In summary, LGB individuals have been described as an at-risk group based on the high level of homophobia on both societal and individual levels. Such experiences with homophobia impact the way LGB individuals view themselves, particularly how they define their sexual minority identities which have been historically marginalized and stigmatized. Consequently, negative views of self result from the internalization of society’s negative attitudes towards LGB individuals. Internalized homophobia has been documented as a potential disruption to the coming out process as it impacts an LGB individual’s decision to be closeted completely, come out to selected individuals, or come out to all (Cabaj, 1997). Disclosure or non-disclosure to family, friends, and colleagues and how it is impacted by internalized homophobia warrants attention from researchers as it has significant implications in the lives of LGB individuals.

Purpose of the Study

The purpose of the present study was to gain a better understanding of the relationship between levels of outness to family, friends and colleagues and internalized homophobia. Conducting research on risk factors that negatively impact the coming out process, such as internalized homophobia, will generate knowledge that will help reduce the stress unique to LGB individuals. Such research also will increase the provision of quality and effective support to cope with stress for this historically underserved population group (Iwasaki & Ristock, 2007).

We hypothesized that internalized homophobia would predict whether one comes out to all family (nuclear and extended family), friends, and colleagues. Internalized homophobia and concerns about coming out contributes to an LGB individual’s reluctance to enter the ‘scene’ or culture which is related to their sexual identity (Ridge, Plummer, & Peasley, 2006). In fact, internalized homophobia has prevented some LGB individuals from never finding their true selves, creating a further disconnection from their true identities. Based on this finding as well as others, we propose that LGB individuals with high levels of internalized homophobia would be less likely to come out as LGB to all family (nuclear and extended family), friends and colleagues. If issues related to internalized homophobia, a well-documented risk factor for stress among LGB individuals, are addressed, improvement in the mental health and overall quality of life for LGB individuals can occur (Wagner et al., 1996).

Method

Participants
Two hundred ninety individuals between the ages of 18 and 71 responded to our study. Forty-seven percent (n = 131) of respondents identified as lesbian, 42% (n = 117) as gay, and 4% (n = 12) as bisexual. More than half of the respondents identified their gender identity as woman (51%, n = 154), 45% (n=127) as man, 2% (n = 5) as transgender, and 2% (n = 5) as “other.” Seventy-three percent (n = 204) had an associate’s degree or higher, and 69% (n=192) identified as White (see Table 1 for complete demographics). Due to the small number of transgender respondents, we did not examine their experiences by gender identity. We do recognize, however, the unique interaction between gender identity and sexual identity, and encourage future research in this area.

Materials

Levels of Outness. The questions used in this study that assessed level of outness of participants were adapted with permission from a survey developed by Rankin (2003). These questions are part of a larger campus climate survey that is used nationally to assess campus climate for community members. This set of questions showed high internal consistency (α = .80). Using a varimax rotation, items load as one factor and account for 65% of the variance.

Internalized Homophobia Scale (IHP; Martin & Dean, 1987). The Internalized Homophobia Scale is a 9-item measure adapted for self-report. Previous research has indicated that the self-administered version of the IHP scale has acceptable internal consistency and correlated as expected with relevant measures (Herek & Glunt, 1995). Items are administered with a 5-point response scale, ranging from disagree strongly to agree strongly. Reliability coefficients for this scale are typically higher for men (α = .83) then women (α = .71).

Procedure

An online survey was created through PsychData, a Web-based company that conducts Internet-based research in the social sciences. Participants were invited through email advertisements to general and multicultural LGBT list-servs. Personal networks also were utilized. Participants were made aware of the intentions of the survey and the topics they would encounter. Participation was anonymous and all respondents reviewed and gave informed consent before initiating the study. (Appropriate IRB approval was obtained).

Results

A set of regression procedures were conducted to examine how “coming out” to friends, family, and colleagues predicted scores on the Internalized Homophobia Scale (IHP). Table 2 shows the complete regression summaries. Model 1 regressed demographic variables: age, self-identified gender, ethnicity, education level and reported income. This model accounted for 4% of the overall variance with education level contributing most to the prediction of IHP scores (β = -.15, p < .05). This model was used in each of the following hierarchical models as a first step to control for demographics to examine the prediction value of each “coming out” variable.

Model 2 emerged as a significant model. Coming “out to friends” was added as a second step to the model and accounted for an additional 11% of the variance after controlling for demographics. According to the standardized regression coefficients, this variable provided a significant contribution to the prediction of IHP scores (see Table 2). Model 3 did not emerge as a significant model. By including coming “out to nuclear family” only an addition 1% of the total variance was accounted for. Within the third model, coming “out to friends” remained the largest contributor to the prediction of internalized homophobia (β = -.28, p < .05).

Model 4 and Model 5 emerged as significant models. In Model 4, the second step added coming “out to extended family” and contributed 2% to the total variance. Standardized regression coefficients indicated coming “out to friends” and “out to extended family members” were the strongest contributors to the model. By adding “out to colleagues” to the second step of the fifth model, an additional 2% of the variance was accounted for beyond demographics. “Out to colleagues” contributed the most to the predication of internalized homophobia beyond demographic differences, coming out to friends, coming out to nuclear family, and coming out to extended family (β = -.18, p < .05). Model 5 accounted for almost 19% of the total variance.

Discussion

The findings from our study suggest internalized homophobia impacts whether one is out to friends, colleagues, and extended family, but not to nuclear family. These findings are surprising as we hypothesized internalized homophobia would impact whether one is out to all family members (nuclear and extended), friends, and colleagues. Specifically, we hypothesized that higher internalized homophobia would lessen the likelihood that LGB individuals disclose as lesbian, gay, or bisexual to all family (nuclear and extended), friends, and colleagues. This assumption was based on the professional literature that underscored the fact that experiences in an anti-gay society can lead LGB individuals to internalize prejudicial messages and have negative views of self, and the potential consequences of coming out to family (family crisis), friends (disconnection and loss of friends), and work colleagues (dismissal and mistreatment; Hunter, 2007; Rotheram-Borus & Langabeer, 2001; Savin-Williams & Ream, 2003).

Education level also was a strong predictor of internalized homophobia for the sample in this study. Education level may be influential because individuals who are more “in the know” may accept that internalized homophobia is a barrier to self-acceptance and therefore an issue worth addressing and resolving. Further, coming out to friends and colleagues contributed strongly to internalized homophobia which may be a result of the experiences of LGB individuals in an anti-gay society and the possibility that friends and colleagues represent non-affirming members of our society. Therefore, the greater the discomfort with one’s same gender sexual identity, the less likely a LGB individual will come out to friends or co-workers for fear of negative consequences.

Although Hunter (2007) posited that LGB people most often come out to friends first, our study underscores a unique relationship between internalized homophobia and coming out to friends in that respondents with higher internalized homophobia were less out to friends. Findings from the National Lesbian Health Care Survey (NLHCS; Bradford, Ryan, & Rothblum, 1993) support this finding from our study. Correlations from the NLHCS suggest lesbians with higher internalized homophobia feared exposure as a lesbian to heterosexual friends. Furthermore, 88% of lesbians from the NLHCS were out to other LGB individuals, but only 28% were out to heterosexual friends. Perhaps respondents in our study who had higher internalized homophobia had similar fears regarding disclosure to heterosexual friends, particularly those who were non-affirming of LGB sexual identities. Furthermore, based on the results of our study and the professional literature, it is possible to assert that respondents from our study who had lower internalized homophobia were more comfortable coming out to friends who were affirming of LGB sexual identities.

Research suggests that LGB individuals who are more open at work experience higher levels of job satisfaction, commitment to the workplace, the fostering of a healthy identity, and the encouragement of employers to promote a diverse workplace (Day & Shoenrade, 1997; Griffith & Hebl, 2002; King, Reilly, & Hebl, 2008). While there are positive aspects of research surrounding coming out at work, research also suggests that more than two-thirds of LGB people think coming out to the workplace would create problems (i.e., not being hired, not being promoted, not receiving support and mentorship necessary for professional development, or loss of job; Hunter, 2007). The context in which an individual comes out at work is much more important than the situational factors which lead them to come out (King, Reilly, & Hebl, 2008). Consequently, many LGB individuals stay closeted at work in anticipation of rejection, which is often based on a lack of legal protection or personal experiences with an anti-gay organizational climate.

Our study uncovered a strong relationship between internalized homophobia and level of outness at work. In fact, outness to colleagues was the largest predictor of internalized homophobia above and beyond all other variables analyzed in this study. Based on this finding, we defend previously cited research that LGB individuals are more likely to be out and experience less internalized homophobia when they have had positive experiences with coming out in the past, or when their organizations are gay-friendly, include written non-discrimination policies and advocate on behalf of LGB people (i.e., offer trainings and workshops that incorporate LGB issues; Griffith & Hebl, 2002). Friskopp and Silverstein (1995) concur with our findings by suggesting those who disclosed at work were not only more comfortable with their sexual identity, but also had many previous disclosures with heterosexual friends and relatives. In the same respect, LGB individuals who enter and remain in a workplace where heterosexism and homophobia are pervasive may never come out to co-workers or may be very selective about to whom they come out (Hunter, 2007). They might decide to pass to divide their work life and personal life, and avoid discrimination at all costs (DeJordy, 2008). Passing, while helpful in the organizational environment, can be harmful to the individual because it reduces an individual’s authenticity of one’s behavior, lowers one’s self-esteem, and denies or suppresses an individual’s LGB identity.

Results from the NLHCS (Bradford, Ryan, & Rothblum, 1993) support Hunter (2007) and our research: lesbians who were less out to co-workers had more fear of exposure as lesbian. For some LGB individuals, “just the thought of disclosure at work typically creates considerable anxiety” (Hunter, 2007, p. 124). This might be true for the participants in our study.

Finally, our hypothesis that internalized homophobia will predict outness to all family members, including nuclear and extended, was partially supported by our results. In particular, internalized homophobia was not a predictor of outness to nuclear family, but was a predictor of outness to extended family.

The fact that internalized homophobia did not predict outness to nuclear family was surprising considering the high degree of difficulty and anxiety associated with coming out to parents, the anticipated rejection by the nuclear family, and the fact that many LGB individuals remain closeted to family members indefinitely or until later in life (Hunter, 2007). Paul and Frieden (2008) contend that negative social messages about LGB sexual identities, particularly those made by family, friends, and religious organizations, increases the challenge of self-acceptance as LGB. With a lack of self-acceptance coupled with “fears related to a potential loss of relationship with specific family members,” LGB individuals might refrain from disclosing their sexual minority identities (Paul & Frieden, 2008, p. 43). It could be assumed that internalized homophobia would affect the act of coming out to family, particularly nuclear family, since “there is no predicting” how parents will react, and disclosure could cause “great turmoil in the home” (Hunter, 2007, p. 95.). Based on the aforementioned assumption, our initial hypothesis would stand. This conception, however, was not supported by the results of our study as internalized homophobia predicted outness to extended family and not nuclear family. It appears that the disclosures or lack of disclosures to nuclear family by participants in our study were not influenced by internalized homophobia. Future research that explores factors that impact disclosure to nuclear family is warranted in order to more fully understand this relationship.

Implications for Counseling

This study presents many implications for counselors. First, experiences with internalized homophobia can impact the lives of LGB individuals, particularly the coming out process.

“If one has a high level of internalized homophobia, the [coming out] process can be fraught with turmoil; however, if the individual is able to connect with supportive people who can help him or her dispel the negative attitudes of society, that state is temporary. This is an area in which counselors can aid in the process” (Matthews, 2005, p. 212).

An affirmative counselor can model a positive reaction to an LGB client’s disclosure, provide a corrective emotional experience for that client, and instill hope that positive consequences can result from coming out. This can help the client externalize his or her experiences with homophobia, and move towards self-acceptance (Matthews, 2007). Ridge, Plummer, and Peasley (2006) found that positive self-talk, writing about problems, and making more positive choices were helpful when an individual is looking to defeat feelings of internalized homophobia. On the other hand, a counselor who perpetuates messages of homophobia or heterosexism can reinforce the negative experiences of the LGB client, and thus cause more distress and heartache.

It is essential that affirmative counselors avoid heterosexism in clinical practice (i.e., review clinical paperwork for heterosexist language; decorate office to be inclusive of diverse sexual identities; advocate for a non-discrimination policy that is inclusive of sexual and gender identity). A counselor also must overcome heterosexism through self-examination and self-education where biases and prejudices are identified and dispelled (Matthews, 2007). Additionally, it is necessary for affirmative counselors to develop the knowledge and skills necessary for working with LGB clients. Continuing education opportunities such as conference workshops and graduate classes that focus on LGB issues are excellent ways to enhance a counselor’s multicultural competency to work with LGB clients. Familiarizing oneself with the LGB community (local and national) by attending LGB venues (i.e., parades, community centers, LGB bookstores), and learning key LGB figures who contributed to LGB rights through movies and literature are all important steps in becoming an affirmative counselor.

“Personal contact is the most consistently influential factor in reducing prejudice” (Hunter, 2007, p. 168). Therefore, it is invaluable for affirmative counselors, particularly heterosexual counselors, to spend time with LGB people. This will help challenge misconceptions and messages that have been learned as members of a society that perpetuates anti-gay attitudes and beliefs in many domains. Counselors must help clients explore and discover how they wish to self-identify, whether it is lesbian, gay, bisexual, queer, or questioning another identity. It is important to use caution in assigning the client an identity before he or she is ready to self-identity. It is beneficial for counselors to utilize sexual minority identity development models (see, for example, Cass, 1979; D’Augelli, 1994; McCarn & Fassinger, 1996; Troiden, 1979). Although these models present stages or phases that are often experienced during the coming out process, it is important to use them as guides as each LGB client is unique and may experience coming out differently.

Coming out can be a risky process, but also an empowering experience for LGB individuals (Matthews, 2007). Consequently, as a counselor, it is important to consider the potential dangers and benefits of disclosing to various individuals in the LGB client’s life. A LGB client might decide not to disclose to a particular individual because the negative consequences outweigh the positives. Counselors should support the decisions made by clients, and always ensure their personal safety (Hunter, 2007). Although there might be consequences as a result of disclosure, there will likely be long-term gains in self-acceptance and overall psychological health for LGB individuals.

It also is very important for an LGB individual to establish a connection to the LGBT community (Matthews, 2007). As a counselor, it is vital to be able to promote exposure to and interaction with positive elements of the LGB community. There are a number of online options such as support groups, chat rooms, and list-servs. Community options include LGBT community centers, support groups at counseling centers, and LGBT-sponsored events. Counselors should be familiar with these resources and prepared ahead of the counseling session to share them with a LGB client. Caution should be used in identifying resources to ensure they are safe and healthy avenues for support.

Limitations and Areas for Future Research

A possible limitation of this research is that it represents a one-time measurement of self-reported data. Such complex perceptions of being closeted and the corresponding feelings of internalized homophobia may be viewed as a dynamic process subject to change over time and experiences. Moradi, Mohr, Worthington, and Fassinger (2009) suggest using experimental, repeated measures designs, and longitudinal designs to best determine causal and or developmental hypotheses regarding sexual minority research areas and would benefit research such as this one. Future research will look toward long-term methods of measuring levels of outness and corresponding feelings of internalized homophobia over time. Additional future research should focus on homophobia and heterosexism in the workplace which, according to a report by the Human Rights Campaign (2001) “occurred in every area of the country, happened in a range of workplaces, and affected employees at all levels” (Smith & Ingram, 2004, p. 59). Although anti-LGB discrimination in the workplace is pervasive in our society, this topic remains under-explored. Finally, best practices to reduce the negative effects of internalized homophobia should be examined. Although internalized homophobia is a strong influential factor to coming out, the exploration of additional risk factors is essential in gaining a stronger understanding of sexual minority identity development.

References

Bobbe, J. (2002). Treatment with lesbian alcoholics: Healing shame and internalized homophobia for ongoing sobriety. Health and Social Work, 27(3), 218–222.
Bradford, J., Ryan, C., & Rothblum, E. (1994). National Lesbian Health Care Survey: Implications for mental health care. Journal of Consulting and Clinical Psychology, 62(2), 228–242.
Brown, L. (1989). Lesbians, gay men, and their families: Common clinical issues. Journal of Gay and Lesbian Psychotherapy, 1(1), 65–77.
Browning, C., Reynolds, A. L., & Dworkin, S. H. (1991). Affirmative psychotherapy for lesbian women. The Counseling Psychologist, 19(2), 177–196.
Cabaj, R. P. (2000). Substance abuse, internalized homophobia, and gay men and lesbians: Psychodynamic issues and clinical implications. In J. R. Guss & J. Drescher (Eds.), Addictions in the gay and lesbian community (pp. 5–24). Binghamton, NY: Haworth.
Cain, R. (1991). Stigma management and gay identity development. Social Work, 36(1), 67–73.
Carpineto, J., Kubicek, K., Weiss, G., Iverson, E., & Kipke, M. D. (2008). Young men’s perspectives on family support and disclosures of same-sex attraction. Journal of LGBT Issues in Counseling, 2(1), 53–80.
Cass, V. (1979) Homosexual identity formation: A theoretical model. Journal of Homosexuality, 4(3), 219–235.
Center for Substance Abuse Treatment. (2001). A provider’s introduction to substance abuse treatment for lesbian, gay, bisexual, and transgender individuals. DHHS Publication No. (SMA) 01-3498. Rockville, MD: CSAT.
D’Augelli, A. R. (1994). Identity development and sexual orientation: Toward a model of lesbian, gay, and bisexual development. In E. W. Trickett, R. J. Watts & D. Birman (Eds.), Human diversity: Perspectives on people in context. San Francisco, CA: Jossey-Bass.
D’Augelli, A. R., Grossman, A, H., & Starks, M. T. (2005). Parents’ awareness of lesbian, gay, bisexual youths’ sexual orientation. Journal of Marriage and Family Therapy, 67, 474–482.
D’Augelli, D. & Hershberger, S. L. (2002). Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school. School Psychology Quarterly, 17, 148–167.
Davies, D. (1996). Homophobia and heterosexism. In D. Davies & C. Neal (Eds.), Pink therapy: A guide for counselors and therapists working with lesbian, gay, and bisexual clients (pp. 41–65). Buckingham, England: Open University Press.
Day, N., & Schoenrade, P. (1997). Staying in the closet versus coming out: Relationships between communication about sexual orientation and work attitudes. Personnel Psychology, 50(1), 147–163.
DeJordy, R. (2008). Just passing through – stigma, passing, and identity decoupling in the work place. Group and Organization Management, 33(5), 504–531.
Diamond, D. L., & Wilsnack, S. C. (1978) Alcohol abuse among lesbians: A descriptive study. Journal of Homosexuality, 4(2), 123–142.
Flowers P., & Buston K. (2001). “I was terrified of being different”: Exploring gay men’s accounts of growing-up in a heterosexist society. Journal of Adolescence, 24(1), 51–65.
Friskopp, A., & Silverstein S. (1995). Straight jobs, Ggay lives: Gay and lesbian professionals, the Harvard Business School, and the American workplace. New York, NY: Scribner.
Galupo, M.P. (2006). Sexism, heterosexism, and biphobia: The framing of bisexual women’s friendships. Journal of Bisexuality, 6(3), 35–45.
Griffith, K. H., & Hebl, M. R. (2002). The disclosure dilemma for gay men and lesbians: “Coming out” at work. Journal of Applied Psychology, 87(6), 1191–1199.
Herek, G. M. (1996). Heterosexism and homophobia. In R. P. Cabaj & T. S. Stein (Eds.), Textbook of homosexuality and mental health (pp. 101–113). Washington, DC: American Psychiatric Press.
Herek, G. M., & Glunt, E. K. (1995). Identity and community among gay and bisexual men in the AIDS era: Preliminary findings from the Sacramento Men’s Health Study. In G. M. Herek & B. Greene (Eds.) AIDS, identity, and community: The HIV epidemic and lesbians and gay men (pp. 55–84). Thousand Oaks, CA: Sage.
Hoang, M., Holloway, J., & Mendoza, R. H. (2011). An empirical study into the relationship between bisexual identity congruence, internalized biphobia and infidelity among bisexual women. Journal of Bisexuality, 11, 23–38.
Hunter, S. (2007). Coming out and disclosures: LGBT persons across the life span. Binghamton, New York, NY: Haworth.
Iwasaki, Y., & Ristock, J. (2007). The nature of stress experienced by lesbians and gay men. Anxiety, Stress and Coping: An International Journal, 20(20), 299–319.
King, E. B., Reilly, C., & Hebl, M. (2008). The best of times, the worst of times – exploring dual perspectives of “coming out” in the workplace. Group and Organization Management, 33(5), 566–601.
Knous, H. M. (2005). The coming out experience for bisexuals: Identity formation and stigma management. Journal of Bisexuality, 5(4), 37–59.
Kus, R. J. (1988). Alcoholism and non-acceptance of gay self: The critical link. Journal of Homosexuality, 15(1-2), 25–41.
Lewis, C. E., Saghir, M. T., & Robins, E. (1982). Drinking patterns in homosexual and heterosexual women. Journal of Clinical Psychiatry, 43(7), 277–279.
McCarn, S. R., & Fassinger, R. E. (1996). Re-visioning sexual minority identity formation: A new model of lesbian identity and its implications for counseling and research. The Counseling Psychologist, 24(3), 508–534.
McGregor, B., Carver, C., Antoni, M., Weiss, S., Yount, S., & Ironson, G. (2001). Distress and internalized homophobia among lesbian women treated for early stage breast cancer. Psychology of Women Quarterly, 25(1), 1–9.
Martin, J., & Dean, L. (1987). Ego-dystonic Homosexuality Scale. School of Public Health, Columbia University.
Matthews, C. R. (2007). Affirmative lesbian, gay, and bisexual counseling with all clients. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients, (2nd ed., pp. 201–219). Washington, DC: American Psychological Association.
Moradi, B., Mohr, J., Worthington, R. L., & Fassinger, R. (Guest Eds.) (2009). Special Issue: Advances in research with sexual minority people. Journal of Counseling Psychology, 56(1), 23–43.
Neisen, J. H. (1990). Heterosexism: Redefining homophobia for the 1990’s. Journal of Gay and Lesbian Psychotherapy, 1(3), 21–35.
Paul, P., & Frieden, G. (2008). The lived experience of gay identity development: A phenomenological study. Journal of LGBT Issues in Counseling, 2(1), 25–52.
Rankin, S. (2003). Campus climate for sexual minorities: A national perspective. New York, NY: National Gay and Lesbian Task Force Policy Institute.
Rankin, S., Weber, G., Blumenfeld, W., & Frazer, S. (2010). 2010 State of Higher Education for LGBT People. Charlotte, NC: Campus Pride.
Reynolds, A. L., & Hanjorgiris, W. F. (2000). Coming out: Lesbian, gay, and bisexual identity development. In R. M. Perez, K. A. DeBord, & K. J. Bieschke (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients, (pp. 35–55). Washington, DC: American Psychological Association.
Ridge, D., Plummer, D., & Peasley, D,. (2006). Remaking the masculine self and coping in the liminal world of the gay ‘scene’. Culture, Health & Sexuality, 8(6), 501–514.
Rosario, M., Schrimshaw, E. W., Hunter, J., & Braun, L. (2006). Sexual identity development among lesbian, gay, and bisexual youths: consistency and change over time. Journal of Sex Research, 43(1), 46–58.
Ross, M. W., & Rosser, S. B. (1996). Measurement and correlates of internalized homophobia: A factor analytic study. Journal of Clinical Psychology, 52(1), 15–20.
Rotheram-Borus, M. J., & Langabeer, K. A. (2001). Developmental trajectories of gay, lesbian, and bisexual youth. In A. D’Augelli, & C. Patterson (Eds.), Lesbian, gay, and bisexual identities and youth: Psychological perspectives (pp. 97–128). Oxford: Oxford University Press.
Rowen, C., & Malcolm, J. (2002). Correlates of internalized homophobia and homosexual identity formation in a sample of gay men. Journal of Homosexuality, 43(2), 77–92.
Saghir, M. T., & Robins, E. (1973). Male and female homosexuality: A comprehensive investigation. Baltimore, MD: Williams and Wilkins.
Savin-Williams, R. C., & Ream, G. L. (2003). Sex variations in the disclosure to parents of same-sex attractions. Journal of Family Psychology, 17, 429–438.
Selvidge, M. (2000). The relationship of sexist events, heterosexist events, self-concealment and self-monitoring to psychological well-being in lesbian and bisexual women. Unpublished doctoral dissertation, University of Memphis, Memphis, Tennessee.
Shapiro, D.N., Rios, D., & Stewart, A.J. (2010). Conceptualizing lesbian sexual identity development: narrative accounts of socializing structures and individual decisions and actions. Feminism & Psychology, 20(4), 491–510.
Smiley, E. B. (1997). Counseling bisexual clients. Journal of Mental Health Counseling, 19, 373–382.
Smith, N. G., & Ingram, K. M. (2004). Workplace heterosexism and adjustment among lesbian, gay, and bisexual individuals: The role of unsupportive social interactions. Journal of Counseling Psychology, 51(1), 57–67.
Spencer, S. M., & Patrick, J. H. (2009). Social support and personal mastery as protective resources during emerging adulthood. Journal of Adult Development, 16, 191–198.
Stall, R., & Wiley, J. (1988). A comparison of alcohol and drug use patterns of homosexual and heterosexual men: The San Francisco Men’s Health Study. Drug and Alcohol Dependence, 22(1-2), 63–73.
Stein, T. S., & Cabaj, R. P. (1996). Psychotherapy and gay men. In R. P. Cabaj & T. S. Stein (Eds.), Textbook of homosexuality and mental health (pp. 413–432). Washington, DC: American Psychiatric Press.
Troiden, R. (1979) Becoming homosexual: A model of gay identity acquisition. Psychiatry, 42(4), 362–373.
Wagner, G., Brondolo, E., & Rabkin, J. (1996). Internalized homophobia in a sample of HIV+ gay men, and its relationship to psychological distress, coping, and illness progression. Journal of Homosexuality, 32(2), 91–106.
Weber, G. N. (2008). Using to numb the pain. Journal of Mental Health Counseling, 30(1), 31–48.

Genevieve Weber-Gilmore and Sage Rose are Assistant Professors at Hofstra University. Rebecca Rubinstein is a graduate student in Rehabilitation and Mental Health Counseling at Hofstra University. Correspondence can be addressed to Genevieve Weber-Gilmore, Hofstra University, Department of Counseling and Mental Health Professions, Hempstead, NY, 11549-1000, genevieve.weber@hofstra.edu.