Same-sex couples in therapy: what is the same and what is different

They sit in the car outside the door for five minutes longer than necessary. “If she asks which of us is the man in the relationship, I’m getting up and leaving,” says one. The other smiles, though not really. They have come because of arguments about who does more at home and why they have barely talked for the past year. But before they can speak about that, they have to check something other couples do not: whether they will be accepted as a couple in this room at all.

That double task is a good introduction to the subject. Same-sex couples come to therapy for the same reasons as everyone else: arguments, distance, infidelity, children, money, in-laws. At the same time they bring a layer that different-sex couples do not know, and that layer is not in their relationship but around it.

In this post I would like to separate the one from the other: what is the same for same-sex couples, what really is different, what the research shows, and what you are entitled to expect from a therapist. I am writing for couples who are considering therapy, and for anyone who would like to understand friends, children or siblings better.

First, what is the same

Love, attachment and conflict follow the same laws regardless of the partners’ gender. In a same-sex couple, too, one partner more often pursues and the other more often withdraws. Here, too, an argument about the dishes is rarely about the dishes. Here, too, each person brings into the relationship what they learned about closeness at home, and wonders why a partner’s silence hits so hard.

The psychologist Lawrence Kurdek spent more than two decades comparing gay, lesbian and different-sex couples. His 2005 summary is relatively simple: the factors that predict satisfaction and how long a relationship lasts are largely the same for all couples. Trust, a sense of equality, the way disagreements are handled, support from those around you. Where he did find differences, they were small and often in favour of same-sex couples, for instance in a more even division of household work.

It matters to say this at the outset because of history. The American Psychiatric Association removed homosexuality from its list of mental disorders in 1973, and the World Health Organization did so in 1990. Sexual orientation is not a problem for therapy to solve. When a same-sex couple comes to couples therapy, the subject of the work is the relationship, just as it is for everyone else.

What Gottman and Levenson’s study showed

John Gottman and Robert Levenson, whom most people know from their research on married couples, also followed 21 gay and 21 lesbian couples over twelve years with their colleagues, and compared them with different-sex spouses. The couples were filmed while discussing a point of disagreement, and the researchers observed how they opened the conversation, how they responded and how they calmed down. The results were published in 2003.

Two findings are cited most often. The first: same-sex partners, on average, raised a contentious issue more kindly, with more humour and affection and with less belligerence and fewer attempts to dominate. The second: what harmed the relationship was the same as in different-sex couples. Contempt, defensiveness and withdrawal are no less corrosive when both partners are the same gender. There is more on these patterns in the post The Four Horsemen in relationships: Gottman’s predictors of a breakup and in the knowledge base under The four horsemen.

I have to pause here, because this study is often summarised too enthusiastically. The sample was small. The couples were volunteers from one area of the United States, the data are more than two decades old, and direct replications on larger samples are few. It does not follow that same-sex couples are “better at relationships”. What follows is something more modest and more useful: nothing suggests that same-sex relationships are more fragile by nature, and it seems that couples who cannot lean on pre-assigned gender roles more often genuinely negotiate many things. I will come back to this.

The left-hand column is the reason a couple comes. The right-hand column is often the reason the difficulties in the left one are harder to settle. Below I go through the right-hand one in order.

What is different: a burden that comes from outside

In 2003 Ilan Meyer described minority stress: the additional, chronic strain people carry because of stigma, not because of anything about themselves. It includes open experiences of rejection and discrimination, but also quieter things: expecting rejection to come, constantly judging whom to tell and whom not, and internalised messages from the environment about what is “normal”. I explain the concept in detail in the post Minority stress: the load those around you do not see, so I will not repeat it here.

For couples, an addition proposed in 2015 by Allen LeBlanc, David Frost and Richard Wight is important. They pointed out that minority stress is not only carried by each individual separately; the couple also experiences it as a couple. Some strains exist only because you are together: whether you can hold hands in the street, how you introduce yourselves to a new neighbour, whether your partner will also be welcome at a family celebration, what you say to a doctor who asks for the “next of kin”. Each of these small decisions costs some attention, and a same-sex couple makes more of them than those around them imagine.

In their 2017 review of the research, Sharon Rostosky and Ellen Riggle summarised that more minority stress is, on average, associated with lower relationship satisfaction. But they also described the other side: many couples build a sense of being a team out of facing prejudice together. Stress from outside, then, does not erode a relationship by itself. What decides the matter is whether the couple recognises it as something external or unconsciously attributes it to each other.

How stress from outside becomes an argument between you

The mechanism is simple, and every couple who has ever brought a hard day at work home knows it. The difference is that with minority stress the source is often invisible, even to the person carrying it.

This is how the fourth step can sound before a couple recognises it:

(composed, not a real person)
“You introduced me to your family as a friend again.”
“What was I supposed to say? You know what my father is like.”
“I know. But when you say that, I sit there for three hours as someone who doesn’t exist.”
“Do you think it’s easy for me?”
“No. I think we’re both tired of the same thing, and we’re arguing with each other.”

That last sentence is the turn we look for in therapy. Neither of them is entirely right, and neither is to blame for the lunch being hard work. One needs to be seen. The other needs not to lose his father. Both needs are real, and both arose outside their relationship.

Who knows about us: different openness and the family of origin

One of the most common tensions described in the literature on same-sex couples is a difference in how open each partner is before the world. One told their family at twenty; the other, at forty, has not yet. One talks at work about “my partner”, the other about “my flatmate”. The difference itself is not the problem. Each has their own history, their own family and their own judgement of what is safe. The problem arises when partners read it as a measure of love: “If you really loved me, you would tell them.” “If you really loved me, you wouldn’t push me.”

There is no correct pace here. Coming out is each individual’s decision, and in couples therapy it should not become a demand one partner makes of the other. The aim is for both to understand what hiding costs the one who is hidden, and what disclosure puts at risk for the one who fears it. How such a conversation with family unfolds in adulthood, I describe in the post Coming out to your family as an adult: when you tell them who you are.

Even when the family knows, that does not yet mean it recognises the couple. There is a wide in-between zone: parents who politely accept a partner but do not invite them into the family photograph, a grandmother who “doesn’t need to be told”, a brother who makes jokes. The question of how far to adapt to a family of origin and where to draw a boundary is familiar to all couples. I wrote about it in the post In-laws and boundaries: families of origin in a relationship. For same-sex couples the stakes are higher, because this is not about who cooks Christmas lunch. It is about whether the couple exists at all in the family’s eyes.

As early as 1991, the anthropologist Kath Weston described in her book Families We Choose how gay men and lesbians often build a chosen family alongside this: a circle of friends, former partners and close people that takes on the role relatives otherwise have. Kurdek later found something similar: same-sex couples on average receive less support from relatives and more from friends. For therapy this means the question “who is your family” has no self-evident answer. When we draw a genogram, it also includes people who are not related to us but are there when things are hard.

Fewer ready-made roles: freedom and extra work

Different-sex couples, like it or not, inherit a script: who is supposed to make the first move, who looks after the home, who earns more, how the steps follow from dating to living together. The script is often unfair, and many couples struggle with it. But it is available as a starting point from which you can depart.

In their chapter on therapy with gay and lesbian couples, Robert-Jay Green and Valory Mitchell describe this as relational ambiguity: same-sex couples have fewer pre-given rules about what their relationship is and what commitments within it mean. When are we a couple? What does it mean that we live together? How do we divide work, money and care if gender does not decide it for us? How will we, if we will, become parents?

This is both freedom and work. Freedom, because you can shape the relationship to your own measure. Work, because everything that is “taken for granted” by others has to be genuinely talked about. When the conversation does not happen, each lives by their own unspoken script and is surprised that the other is not playing the same game. Many arguments that appear to be about housework or free time are in fact about agreements that were never made. How to open such a conversation, I described in the post How to start a difficult conversation with your partner: the first three minutes decide.

What you are entitled to expect from a therapist

Let us go back to the car from the beginning. The fear of the question “who is the man in the relationship” is not exaggerated. Many people have had an experience with a professional who was clumsy, curious in the wrong way, or openly rejecting. So it is right that you know what the basic standard is.

First: nobody will try to change your orientation, and nobody will hint that it is the cause of your difficulties. In 2009, after reviewing the research, the American Psychological Association concluded that there is no reliable evidence that attempts to change sexual orientation work, and that they can cause harm. Its 2021 guidelines for work with sexual minority persons expect therapists to take a respectful and affirming stance and to understand the impact of stigma.

Second: you should not have to lecture your therapist. You can expect them to know concepts such as minority stress and chosen family, and not to assume that one of you is “more masculine” or “more feminine”. At the same time, a good therapist does not know everything in advance. They will ask how the two of you live this, since same-sex couples are not all alike. Two women in their sixties who have hidden all their lives and two men of twenty-five who are open everywhere have little in common.

Third: the therapist must not slide into either of two extremes. One is explaining all your difficulties through your orientation. The other, equally mistaken, is the claim “to me all couples are the same”, which overlooks the right-hand column in the picture above. Equality of respect does not mean blindness to circumstances.

Before the first session, or during it, you may ask directly: Do you have experience or knowledge of working with same-sex couples? How do you view same-sex relationships? What do you do when there is something you are not familiar with? You may put the same questions to me. I am a marriage and family therapist in training under supervision, and I will answer you plainly, even when the answer is “I don’t know that yet” or “I am not the right person for this”. What the beginning looks like, I described in the post What happens in a first couples therapy session.

An exercise for two: a map of the outside burden

The exercise takes about half an hour. It works best on a calm evening, not in the middle of an argument. Its purpose is to separate what comes from outside from what really is between you.

1. Each of you writes down three situations from the past month in which something pressed from outside because you are a same-sex couple. It can be small: a colleague’s question, a look in the street, a visit to parents, a form with boxes for “husband” and “wife”.
2. Next to each situation, write what you did afterwards. Did you go quiet? Were you irritable at home? Did you retreat behind a screen? Did you seek closeness? No judging, just description.
3. Swap sheets and read in silence. Then each of you names one thing you did not know about the other. No correcting, and no “you could have told me”.
4. Together choose one situation that keeps recurring, and agree on a sentence or a signal with which you will name it to each other next time. For example: “That came from outside.” The sentence does not demand a solution. It only says that you are not opponents.
5. Write down who supports you as a couple. Not each of you separately, but the two of you. The Map of your support network in the knowledge base can help. If the list is short, that is not your fault. But it is information you can do something with.

Where this view does not apply

Everything I have written about minority stress carries a trap: it must not become the explanation for everything. Same-sex couples also argue because one is untidy and the other is not, because one fears closeness, because they differ in wanting children, or because one has fallen in love with someone else. If a therapist, or the couple themselves, attribute every difficulty to pressure from the environment, they overlook what needs doing within the relationship. An outside burden releases no one from responsibility for how they treat their partner.

The second limit concerns the research. Most of what we know comes from the United States, from samples of volunteers who are more educated, more urban and more open than average. About couples who live hidden, older couples, couples in smaller towns, and couples in which one partner is bisexual or transgender, we know considerably less. Nor do I know of research on Slovenia that would allow reliable claims about how same-sex couples here experience therapy, so I would rather not guess.

The third limit is safety. Violence happens in same-sex relationships too, and it is talked about even less, because victims fear they will not be believed or that reporting it would mean disclosing their orientation as well. Couples therapy is not the right route in such circumstances, as I explain in the post Why couples therapy is not the right help when there is violence. In immediate danger in Slovenia, call 113 or 112.

And finally: sometimes couples therapy is not the first step at all. Someone who is only just coming to terms with their orientation, with shame, or with rejection by family may first need a space just for themselves, or a community of people with similar experience. In Ljubljana there is the association Legebitra, which exists specifically for LGBT+ people; check with them for the support currently on offer.

When couples therapy makes sense

At the same point as for all couples: when the same argument keeps repeating and nothing shifts, when you no longer talk, when one of you already has one foot out of the door, or when you face a major decision and cannot find a common language. I would add two reasons that are more typical of same-sex couples. The first is when the difference in openness becomes a constant wound. The second is when the relationship with one or both families of origin divides the couple instead of connecting it.

In relational family therapy, in which I am training, in such cases we look above all at what each partner carries from their own family: what they learned there about whether they are loved as they are, and what happens when they show something others do not expect. For people who hid part of themselves from those closest to them for a long time, these are often very live themes. Sessions take place in person in Ljubljana, and they can also be held in English.

If all of this leaves you overwhelmed by hopelessness or by thoughts that you no longer want to live, do not stay alone with it. In Slovenia, call the Samarijan confidential helpline on 116 123 (24 hours a day) or the mental distress line Klic v duševni stiski on 01 520 99 00 (between 7 pm and 7 am).

What to remember

• Same-sex relationships follow the same laws as all others. What builds a relationship and what breaks it down is largely the same.
• What differs is the environment: minority stress, partners’ different openness, uncertain recognition from the family of origin, and fewer ready-made roles.
• Stress from outside readily becomes an argument between you. Once you name it as external, you are no longer opponents.
• From a therapist you are entitled to expect respect, basic knowledge and no attempts to change your orientation. You may ask about this in advance.
• Minority stress does not explain everything. Every couple also has its own, entirely ordinary difficulties that call for work within the relationship.