The Parental Acceptance and Rejection of Sexual Orientation Scale was administered to 256 self-identified lesbian, gay, bisexual, or queer adults who had been out of the closet to their parents for at least 1 year. Principal component analysis revealed a clear two-component solution: parental acceptance and parental rejection. Findings showed that perceived maternal sexual orientation-specific acceptance was higher, and perceived maternal sexual orientation-specific rejection was lower, for gay/bisexual sons compared to their lesbian/bisexual daughters. Results of regression analyses suggest that both perceived sexual orientation specific acceptance and rejection predicted adult children's psychological symptoms after accounting for perceived global parental acceptance and rejection and the child's gender. The scale's utility for research and practice are noted.

This pilot open trial examined the efficacy of attachment‐based family therapy (ABFT) for Israeli sexual and gender minority (SGM) young adults and their persistently nonaccepting parents. Thirty families received up to 26 weeks of treatment, with parental rejection, parental acceptance, and young adults' attachment avoidance and attachment anxiety assessed at baseline, 8, 16, 24, and 36 weeks (three months post‐treatment). Analyses using multilevel growth models revealed that both young adults and their mothers independently reported increases in mothers’ acceptance of their young adult's same‐sex orientation or noncisgender identity. In addition, young adults reported decreases in both parents’ levels of rejection. Also, mothers, but not fathers, reported decreases in their own level of rejection. Finally, young adults reported a decrease in attachment avoidance in their relationships with both mothers and fathers, but not a decrease in attachment anxiety. Importantly, these treatment gains were maintained three months after the end of treatment. Together, these results suggest that ABFT‐SGM, a manualized, affirmative, experiential, family‐based treatment, may be effective in reducing long‐standing parental rejection, promoting parental acceptance, and improving the quality of LGBTQ+ young adults’ relationships with their parents. These findings are encouraging in light of the urgent need for efficacious interventions to reduce family generated minority stress and promote safer, more supportive environments for sexual and gender minority people.

This chapter describes the negative impact that ongoing parental rejection can have on sexual and gender minority individuals and the importance of promoting parental acceptance. It then introduces and describes the structure and intervention strategies of relationship-focused therapy—a time-limited, experiential, family-based treatment specifically designed to increase parental acceptance, reduce parental rejection, and help sexual and gender minority individuals and their parents re-establish or develop loving, supportive, mutually respectful, meaningful relationships. Then, research findings supporting the model are summarized, a clinical vignette illustrating the treatment is presented, and some of the constraints and limitations of the model are noted.

This chapter describes the nature and importance of therapist responsiveness in attachment-based family therapy (ABFT) for sexual and gender minority young adults and their nonaccepting parents (G. M. Diamond et al., 2019). ABFT is a family-based, manualized, experiential, and emotion-and relationship-focused treatment designed for families in which parents have difficulty accepting their adult child's sexual orientation or gender identity.Families come to us for a number of reasons. In some cases, it is the young adult who initiates treatment. They may harbor unresolved anger and hurt about how their parents reacted to their coming out years ago or because their parents are still ashamed and disappointed by them. Others come because they feel guilty about causing their parents pain and are worried about their parents' emotional and physical welfare. These young adults want to be not only heard and validated but also accepted and connected. In other cases, it is parents who initiate the therapy. Some come because, even after years, they remain stuck in their fear, shame, and grief and are looking for a way out. Others come because their relationship with their adult child has become increasingly distant or conflictual and they are afraid to lose their bond with their child.

The fifth and final task of the treatment involves helping family members consolidate the gains they made over the course of therapy and, together, envision and plan for the future. This task is the natural next step after family members have worked through the core conflicts and relational injuries that had undermined their relationship. By this stage of the treatment, parents are committed to, and actively working toward, being more accepting and affirming of their child's minority identity. Although they may still bear some degree of shame, fear, and loss associated with their young adult's identification as lesbian, gay, bisexual, transgender, or queer, those feelings no longer overwhelm them or dictate how they behave. Tension in their relationship with their young adult has decreased, goodwill and good intentions prevail, and there is a newfound feeling of closeness and hopefulness. In some families, by this stage in the therapy parents have already taken dramatic steps, including meeting their young adult's partner and friends for the first time; coming out to their own family and friends; and standing up in the face of heterosexist, homo(trans)phobic comments or various forms of discrimination. Family members have a sense that they are working together toward a shared goal.