Understanding and Working Therapeutically with Loss in Lesbian Women

by Áine McLaughlin

The death of a life-partner and the bereavement that follows can have an overwhelming impact on the life of the person left behind. Literature on spousal loss and widowhood is extensive, however, as Bent and Magilvy (2006) argue there continues to be a marked disparity between what we know about bereavement and what we do not know. Moreover, while recent years have seen a subtle shift towards inclusiveness, the majority of bereavement research and literature is concentrated predominantly on heterosexual married couples (Broderick et al., 2008; Green & Gant, 2008; Whipple, 2006). Its relevance to same sex partner loss, therefore, is not absolute. Given the integral distinctions in legal standing, societal support, sexual identity formation, and masculine/feminine role socialisation between the two groups, it seems misguided at best to assume that the experience of partner loss within married heterosexual relationships can authentically encapsulate and reflect fully the grief experienced within same-sex relationships (Green & Gant, 2008). While research on the loss of a same-sex partner is limited, discussion in this area does include AIDS-related bereavement and the challenges that gay men may experience in this regard. It is also unwise, however, to conclude that the experience of lesbian widows can be deduced from the male experience of AIDS-related bereavement. As Green and Gant (2008) contend, the gay and lesbian community is not a single homogeneous group but rather a wide-ranging, multi-layered and diverse community. What is needed, therefore, is an attempt to understand the complex nature of lesbian relationships and apply this to more recent research and literature on grief and bereavement.

The purpose of this article is to explore the experience of partner loss within the context of a lesbian relationship and attempt to convey the intricacies of this journey. It will focus on the diverse issues faced by lesbian partners and challenges they may encounter as they go through the stages of grief, while paying attention to how a therapist can facilitate and support a client’s engagement with, growth and completion of the grieving process.

Same-sex partner loss
While the grief they experience is similar in many ways to the grief of heterosexual women when their husbands/partners die, Whipple points out that “lesbians who lose their life partner are often not acknowledged as widows, their grief as invisible to society as their relationship has been” (2008: 1). Compounding this sense of invisibility is the serious lack of research on lesbian widows in comparison to heterosexual widows so much so that Walter refers to the former as “truly silent grievers” (2003: 29).

Understanding lesbian relationships
As Whipple (2008) argues, the word lesbian does not describe a homogenous group. Similarly, in their work: ‘Understanding Lesbian Relationships’, Peplau and Amaro argue “there is no such thing as the typical lesbian couple” thus we have to be careful not to oversimplify the complexity of a lesbian relationship and experiences within this dynamic (1982: 234). In saying this, however, we can explore some common themes, voiced by lesbian women about being in a relationship, that are important to use as a backdrop against which dealing with the death of a partner can be set. Research undertaken by Whipple (2008) demonstrates that two women in a relationship are inclined to feel an intense emotional connection. While deeply satisfying for both women, Whipple points out that the cause of this emotional connection may partly be because women in general are socialised to be more feeling and relationship-oriented but she also makes it clear that it may in part be attributed to the oppression that lesbians endure, which in turn results in them turning to each other for sanctuary. While some in the mental health community have pathologised lesbian relationships as being overly entangled, a much needed and long overdue realisation that lesbian relationships are simply different from heterosexual relationships, as opposed to unhealthy, is taking hold (Whipple, 2008). When exploring what lesbian women look for in a relationship, Jones highlights that affection, love and companionship are integral, alongside an ease of intimacy (both physically and emotionally) and reciprocal interdependence (1985). Other factors that are linked to satisfaction within a lesbian relationship are both partners’ equal involvement in the relationship and equality of power (Peplau & Amaro, 1982; Whipple, 2008). Moreover, Peplau and Amaro debunk the popular myth that lesbian relationships adopt heterosexual paradigms wherein one partner adopts a ‘masculine’ role and the other a ‘feminine’ role (1982: 240). Walter (2003) also makes clear in her research that at any given point in time a significant number of lesbians are involved in an intimate and long-term relationship.

Challenges faced by lesbian partners during the grieving process
Heterocentrism and social support
The notion that lesbian communities exist within hidden cultures is well recognised (Walter, 2003). As Deevey argues: “Homophobic or heterosexist values are common within the majority heterosexual culture who are uninformed about or openly hostile toward lesbian individuals and institutions” (1997: 13). While Pachankis and Goldfried (2004) write about homophobia and heterosexism to describe this indirect and oftentimes overt bias towards LGBT individuals. They argue that heterocentrism is best used to describe this bias as it is often not deliberate but rather a mistake on the part of conventional society in not considering the possibility of diversity within sexual orientations. More subtle than homophobia, heterocentrism can be seen in many different guises in the general beliefs and values within a culture that primarily, by default, identifies with all that is heterosexual. The impact can be quite devastating for a lesbian woman and render her feeling anxious, stressed and fearful on top of the feelings associated with just having lost a life-partner. Some lesbian women lead double lives as they work within the heterosexual majority and in private create unseen networks of attachments, supports and interests within the lesbian community. Lesbian women also create families from the networks that they cultivate. These families often act as replacements for “blood family” (Walter, 2003: 30) and can be different from the mainstream heterosexual families. Thus as Walter points out with the inclusion of lesbian kinship we cannot and must not assume that the heterosexual models of family are universal (30).

Another factor which influences the process of grieving is the social factor. Rando (1993), for example, highlights that a lack of permission and social support during mourning can be harmful. This can lead to what Doka (1989) refers to as Disenfranchised Grief. He defines disenfranchised grief as the:

grief experienced by those who incur a loss that is not or cannot be, openly acknowledged, publically mourned or socially supported. Isolated in bereavement it can be much more difficult to mourn and reactions can be complicated.

(37)

The experience of disenfranchised grief can be seen in the narratives of some of the bereaved women that Whipple interviewed in 2006. One woman describes her experience of not having her relationship recognised and therefore feeling invisible:

Robin’s brother gave her eulogy and listed me as her ‘dear friend’ or something like that…Her sons never said anything to me to let on that they even knew or suspected. I am not sure who they thought I was if not their mom’s lover.

(Whipple, 2006: 80)

This lack of acknowledgement assisted in minimising their pain and their relationship and ultimately denied them their right to grieve for the love that they lost. Moreover, what is also interesting is the fact that a number of the women that Whipple interviewed described incidents where they were hurt by other lesbian women that either failed to recognise their grief or did not understand. This had a significant negative impact as some of the women had assumed that the lesbian community would be supportive. On the contrary one woman describes her experience of listening to those people that spoke at her partner Jessica’s memorial service:

I realised that not one person, gay or straight, had so much as mentioned my name as ever being a part of Jessica’s life or having anything to do with it…I have never felt so completely nullified in my life. I had never felt so let down by both my own people and everyone that had known either of us.

(Whipple, 2006: 82)

Disenfranchised grief is not a collective experience of LGBT bereavement, and thus fair consideration should be given to the context in which the loss has taken place and the supports and resilience that are afforded to the bereaved individual (Deevey, 1997; Whipple, 2006). In saying this, however, and as Deevey makes clear, the experience of lesbian widows from family, funerals and memorials was very varied and it is this “unpredictability of caregiving and family responses (that) remains a source of stress and fear in the daily lives of many lesbian women” (Deevey, 1997: 88). Whipple corroborates this assertion by highlighting the divergence in experience between those women that were ‘out’ to friends and family and those that were not.

‘Coming out’
Revealing one’s sexual orientation, to a large extent, is associated with increased social support during the grieving process. It serves to influence how others respond to the grieving lesbian and how she feels about herself. Disclosure, however, can also threaten a woman’s personal safety, family and cultural relationships and economic security (Peplau, 1991). Thus, for some women, as Greene points out, remaining silent about their true identity and romantic relationships is required if the lesbian partner wants to remain part of her own family (1997). It is understandable, therefore, why a number of women negotiate every piece of information that they reveal about themselves and that they sometimes choose to live in what Deevey refers to as “The Rainbow Village” (2000: 9) in order to assist in preserving a level of self-esteem against a heterosexist or homophobic world.

Why might ‘coming out’ be difficult and therefore influence a woman’s grieving process?
Part of lesbian identity formation involves the integration of one’s sexual orientation and desire. In their work, Lesbian Shame: Its Relationship to Identity Integration and Attachment, Wells and Hansen (2003) argue that the stigmatisation that lesbian women face will interfere with this integration process and cause intense feelings of shame and self-loathing (2003: 94). Kaufman (1996) highlights the importance of shame in the formation of identity. He argues that a child who continuously experiences their needs being denied or rejected by their caregiver will, over time, associate distress with shame and, once this correlation is concretised, every time a child experiences distress they will also experience shame. Kaufman (1996) applies this theory to lesbian identity formation in order to encapsulate what happens when a lesbian woman is faced with critical parents, peers and culture. Moreover, LGBT individuals can unconsciously adopt the homophobic values and beliefs in which they live, thus leading to internalised homophobia resulting in self-hatred and loathing (Kaufman, 1996: 95).

Adjustment, coping, and meaning-making
Broderick et al. (2008) argue that due to the interpersonal and social losses that many lesbians may have already had to endure, coupled with the importance that they attach to close intimate relationships, the death of a partner may represent something altogether more significant for a lesbian partner than for a heterosexual partner. In relation to how people make sense of the world around them and take meaning from their experience, adjustment and grief theories place the impact of the death at the centre. A person’s ability to make sense of a death and feel a benefit from it will influence how well a person can adjust to their loss and the new roles that follow. As Broderick et al. (2008) point out, religion has been used by many people as a compass to help navigate a way through their grief and make sense of death. Many lesbian women, however, due to the intolerance they have experienced from religious doctrine do not have this support to help bring them solace, support and direction. Thus they are left feeling bereft and helpless to a certain extent.

Other complications
As Whipple (2008) makes clear there are a number of other complications experienced by lesbian women that may serve to get in the way of their grieving process. These are legal discrimination, lack of support groups and lack of written material on lesbian bereavement. All of these contribute, as Whipple contends, to the “sense of invisibility and disenfranchisement in lesbian widows” (2008: 6).

Working therapeutically with bereaved lesbian partners
The experience that a woman in a same-sex relationship faces when she loses her partner is tinged quite significantly with trials and tribulations that a woman in a heterosexual partnership does not encounter when she loses her partner. Whipple highlights the fact that lesbian women who have encountered mental health professionals often experience being disrespected, including blatant attempts to convert them to heterosexuality (2008). Deevey makes the point that therapists need to be prepared to assist such clients in their journey through loss (1997). Psychotherapists, in order to facilitate this journey, not only need to have sufficient knowledge about the bereavement process but also to commit to understanding the world that a lesbian woman lives in and the impact that this may have on her grief work.

Clinical issues in working with lesbian women in general
As outlined above societal and individual heterocentrism influences how the LGBT community is treated. As therapists we must endeavour to offset these biases in order to establish sound ethical practices when working with LBGT individuals (Pachankis & Goldfried, 2004). There are a number of ways that these biases can manifest within the therapeutic space and awareness of them is key to being able to counteract them. They include the following:

• The therapist attempting to change the sexual identity of the LGBT individual.
• Associating the client’s problem with the fact that they are LGBT while failing to recognise the significant impact that living in a heterosexist society can have on such an individual.
• Making the assumption that the client is heterosexual.
• Focussing on the sexual orientation of the client when this may not
  be the issue.

Such biased practices, as Pachankis and Goldfried argue, cause “distress for an LGBT client at a time when the client is in need of empathic care” (2004: 46). Given the likelihood of these risks to transpire, it is imperative that therapists investigate whether their own training provides them with an adequate foundation, upon which it is their obligation to build, in order to work effectively with such a client group. What is more, therapists that identify as LGBT should also explore the meaning of their own sexual identity and how this impacts on their work with LGBT and heterosexual clients.

LBGT-Affirmative therapy
Some therapists believe that LGBT clients ought to be treated in the same manner as their heterosexual equivalents and that any approach, for example, CBT, can be utilised as long as the therapist incorporates LGBT considerations (Deevey, 1997). Arguing this, however, fails to recognise the unique experiences that many LGBT clients experience throughout their life-time. In order to meet the unique needs of LGBT clients some therapists have developed what is called LGBT-Affirmative Therapy. LGBT- Affirmative therapists, “utilise the body of knowledge that addresses issues specific to LGBT individuals with the purpose of bridging the gaps left by the heterocentric assumptions of the prevailing therapy models” (Pachankis & Goldfried, 2004: 47). Examples of what Affirmative Therapy looks like are as follows: the therapist facilitating the client’s exploration of how oppression has affected them; reducing shame that stems from homosexual thoughts, feelings and behaviours; and allowing expression of anger towards the injustice of oppression and encouraging clients to build up a support network within the LGBT community. Goldfried (2004) also argues that the therapist should support the client in effectively challenging those societal issues that suppress them and facilitate them in acquiring healthy coping mechanisms when this is not possible at this point in history.

Exploring the impact of bereavement tasks
Many of the women interviewed by Deevey (1997) and Whipple (2006) benefited from coming out to chosen friends and family members when their partners passed away. One woman describes the importance of coming out because “she needed someone to understand that this was not my good friend who was dying. I needed my grief to be understood and so I came out to the social worker and chaplain from the hospice” (Whipple, 2006: 109). Supporting clients in their decision to disclose their sexual orientation or not and to whom may play a fundamental role in the therapy. What is more, some women, as Broderick et al. (2008) point out may have come out to family, co-workers, help professionals immediately after the death of their partner and not having gauged correctly the risk that this may present. Thus, therapy may entail exploring a client’s sense of regret or shame related to these disclosures, especially if she was met with negative reactions.

Due to the homophobic experiences of some LGBT individuals, or simply growing up in a heterocentric society, many will be quite sensitive to cues that indicate whether a person is open or not to non-heterosexual relationships. It is imperative that a therapist works hard to cultivate a sense of feeling safe for the LGBT client. Consideration of this should be given in the minutiae of detail, such as hanging LGBT friendly posters in your practice or utilising initial assessment tools that are inclusive and validating of all sexual identities and orientations. As Whipple (2008) makes clear some women’s intimate relationship was only known to themselves and one cannot make the assumption therefore that because a client was in relationship for many years that she is ‘out’ to the world. On the contrary the therapist must gently explore how her client relates to the dominant culture. It may be the case that the therapist is among the first people that the client has told, which emphasises the importance of expressing positive regard, comfort with and acceptance of such a disclosure. Chazin and Klugman in their article ‘Clinical Considerations in Working with Clients in the Coming Out Process’ (2014) outline three affirmative therapeutic responses to such a disclosure. These are:

1. Openly conveying continuing acceptance of the client after receiving this information.
2. Articulating an awareness and appreciation of how difficult it is to disclose given prevailing heterosexist societal norms.
3. Collecting more information about how the client relates to her sexual behaviours, orientation, and identity in a curious and non-judgmental manner.

(46)

By reacting in an affirmative way, according to Chazin and Klugman the therapist is “able to play an important foundation of trust and collaborative inquiry that would inform the remainder of treatment” (2014: 46). This positive response may also serve to motivate the client to disclose to others. There is often the misconception that to have fully integrated one’s lesbian identity one has to be completely out. Recent research, however, demonstrates that LGBT individuals engage in what can be referred to as visibility management, which involves regulating and adjusting exposure based on the context of a given situation (Chazin & Klugman, 2014). It is also useful for the therapist to explore the client’s worries and expectations in relation to how other people may react. It may be useful to integrate some role playing and assertive communication techniques into the therapy as well as providing strategies to regulate emotion and deal with crisis management.

In addition to the above, the therapist must also be aware of expressions of internalised homophobia within the client and confront these in a therapeutic and sensitive manner, so as to help illuminate for the client where these internal beliefs come from. Once this is known the client can work towards letting go of these assumptions and replacing them with healthier ones (2014: 45).

As Broderick et al. (2008) make clear it is also important that the therapist considers a number of other dimensions when working with a lesbian woman who has lost her life-partner. These include the following:

Explore the impact of previous losses: These losses could well be associated with the death of loved ones or they could possibly relate to the experience of having lost family, friends, and connections to spiritual or ethnic communities due to homophobia. These experiences can serve to intensify the client’s feeling of loss, loneliness, desertion and rejection. It is important that the therapist gives time to the expression and embodiment of these feelings.

Explore religious and/or spiritual issues: Some clients may turn to spirituality or religious belief in order to gain solace and make sense of their loss. It is important that the therapist is aware of those communities that are inclusive of the LGBT community and also recognise that failure on the part of certain religious organisations to acknowledge the significance of her loss will justifiably evoke feelings of anger, sadness and shame. All of which should be affirmed in the therapeutic space and attended to with acceptance and non-judgment.

Assess resources for support: Understandably, the death of her partner can also represent the loss of a cushion against homophobia and or heterocentrism. As Whipple (2008) and Deevey (1997) make clear a lot of the women that they interviewed had a range of supports from within the LGBT and heterosexual community, however, it is better not to assume that this is the case for every lesbian woman. Because of this it is important to work with the client in mapping out her support networks.

Consider unique legal conditions: While same-sex marriage was made legal in Ireland in October 2015 this is not case in other countries and can, for example, result in women facing the hardship of losing their home or being denied participation at their partner’s funeral or memorial services. Whipple (2008) highlights the importance of seeing the lesbian partnership as a true marriage and not to underestimate its meaning for the partner left behind nor the devastating impact that this loss has had on her life.

Conclusion
We have seen that there can be challenges faced by lesbian women during their grief process that may invariably make their journey more difficult. These difficulties can take many forms including living in a homophobic and/or heterosexist society; living a double life due to the fear of coming out; the relationship not being recognised by family and/or friends; lack of legal recognition, legal discrimination and a lack of support groups and written material for the grieving lesbian widow. While not all lesbians will experience these difficulties, it is, unfortunately, still the case that a substantial number of them do. As therapists, therefore, it is absolutely imperative that we have an understanding and awareness of the intricacies of a lesbian woman’s grief journey. We have a duty to ensure that we are appropriately trained in this regard and have integrated our own sexuality, in a way that brings into our awareness any prejudices or blind spots that we may have within this dynamic. By embracing the minority both within ourselves and society and ultimately leading a healthier and congruent existence we can facilitate the healing and growth of every client that we have the privilege to work with during their grieving process.

Áine McLaughlin works as a Humanistic and Integrative psychotherapist in Dublin. She can be contacted on peaceofmind.tc@gmail.com and/or at 0877798460.

References:
Bent, K.N., & Magilvy, K. (2006). When a partner dies: Lesbian widows. Issues in Mental Health Nursing, 27(5), 447-459. doi: 10.1080/01612840600599960.

Broderick, D.J., Birbilis, J.M., & Steger, M. (2008). Lesbians grieving the death of a partner: Recommendations for practice. Journal of Lesbian Studies, 12, 2-3.

Chazin, M., & Klugman, S. (2014). Clinical Considerations in Working with Clients in the Coming Out Process, Retrieved 2 December 2014 from: http://pcsp.libraries.rutgers.edu.

Deevey, S. (2000). Cultural variation in lesbian bereavement experiences. Journal of the Gay and Lesbian Medical Association, 4(1), 9-17.

Deevey, S. (1997.) Bereavement experiences in lesbian kinship networks in Ohio. Unpublished doctoral dissertation, Ohio State University. Abstract retrieved from Dissertation Abstracts International, 58(02), 630.

Doka, K. J. (1989). Disenfranchised Grief: Recognizing Hidden Sorrow, New York: Lexington Books.

Greene, B. (1997). Ethnic minority lesbians and gay men: Mental health and treatment issues. In B. Greene, (ed.), Ethnic and Cultural Diversity Among Lesbians and Gay Men: Psychological Perspectives on Lesbian and Gay Issues, Thousand Oaks, CA: Sage.

Green, L., & Grant, V. (2008). Gagged grief and beleaguered bereavements? An analysis of multidisciplinary theory and research to same-sex partnership bereavement. Sexualities, 1(3), 275-300. doi: 10.1177/1363460708089421.

Jones, L.S. (1985). The psychological experience of bereavement: Lesbian women’s perceptions of the response of the social network to the death of a partner. Unpublished doctoral dissertation, Boston University. Abstract retrieved from Dissertation Abstracts International, 46(09), 2566.

Kaufman, G. (1996). The psychology of shame: The theory and treatment of shame-based syndromes (2nd ed.). New York: Springer.

Pachankis, J.E., & Goldfried, M.R. (2004). Clinical Issues in Working with Lesbian, Gay, and Bisexual Clients. Psychotherapy: Theory, Research, Practice, Training, 41(3), 227- 246. doi: 10.1037/0033-3204.41.3.227.

Peplau, L.A., & Amaro H. (1982). Understanding lesbian relationships. Retrieved 15 November 2014 from: http://www.peplaulab.ucla.edu/Peplau_Lab/Publications_files/ Peplau%20%26%20Amaro%2082.pdf.

Peplau, L.A. (1991). Lesbian and gay relationships. In Gonsiorek, J.C., & Weinrich, J.D. (Eds.) Homosexuality: Research Implications for Public Policy, Newbury Park, CA: Sage Publications.

Rando, T.A. (1993). Treatment of Complicated Mourning, Champaign, IL: Research Press.

Walter, C. A. (2003). The Loss of a Life Partner: Narratives of the Bereaved, New York: Columbia University Press.

Wells, G. B., & Hansen, N. D. (2003). Lesbian shame: Its relationship to identity integration and attachment. The Fielding Graduate Institute Journal of Homosexuality, 45(1), 93-110.

Whipple, V. (2006). Invisible grief: Experiences of Lesbian Widows, London: Harrington Park Press.

Whipple, V. (2008). Working with lesbian widows. Grief Matters, Retrieved 2 December 30 2014 from http://www.glhv.org.au/files/lesbian_widows.pdf.