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The Cat and the Cloud: ACT for LGBT

Locus of Control, Responsibility, and
Acceptance
a
Alexander L. Stitt
a
University of Hawaii at Hilo, Hilo, Hawaii, USA
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online: 30 Aug 2014.

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Control, Responsibility, and Acceptance, Journal of LGBT Issues in Counseling, 8:3, 282-297, DOI:
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 Journal of LGBT Issues in Counseling, 8:282–297, 2014
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ISSN: 1553-8605 print / 1553-8338 online
DOI: 10.1080/15538605.2014.933469

The Cat and the Cloud: ACT for LGBT Locus

of Control, Responsibility, and Acceptance

ALEXANDER L. STITT
University of Hawaii at Hilo, Hilo, Hawaii, USA

Advocating acceptance, committed action, and value-guided be-

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havior over experiential avoidance, Acceptance and Commitment

Therapy (ACT) may aid lesbian, gay, bisexual and transgender
(LGBT) clients affected by hetero/homonormative social pressure.
By conceptualizing LGBT paradigms of internal/external con-
trol/responsibility (IC-IR; EC-IR; IC-ER; EC-IR), ACT may be adapted
to a myriad of multicultural worldviews. This article presents lo-
cus of acceptance as the attributed worth of internal/external cues
perceived necessary by the client to achieve self-acceptance. Rec-
ognizing visibility and isolation as recurrent LGBT issues, locus of
acceptances balances identity as individual (internal acceptance)
with identity as community (external acceptance).

KEYWORDS Acceptance and Commitment Therapy, control and

responsibility, cross cultural counseling, internalized homophobia,
LGBT, microaggressions, multicultural counseling, self-acceptance

INTRODUCTION

Although comparative research is required to gauge the effectiveness of

Acceptance and Commitment Therapy (ACT) among lesbian, gay, bisexual
and transgender (LGBT) populations, ACT techniques may prove efficacious
in the exploration of complex sexual and gender schemas. Additionally,
ACT’s emphasis on metaphor provides a creative, nonrestrictive mode for
adults and LGBT youth to discuss sexual orientation, gender identity, gender
expression, and social role.

Address correspondence to Alexander L. Stitt, P.O. Box 1645, Keaau, HI, 96749. E-mail:
astitt@hawaii.edu

282
 The Cat and the Cloud 283

Early behaviorists such as B. F. Skinner advocated contextualism, the

idea that an individual’s worldview is rooted to a few key ontological as-
sumptions or metaphors (Hayes, Barnes-Holmes, & Roche, 2001). Evolving
this concept, Steven Hayes, one of the premier founders of ACT, presented
functional contextualism, allowing individuals to employ their root metaphor
to predict and influence their behavior (Hayes et al., 2001). From this stand-
point, ACT explores clients’ values to understand their worldview, omitting
value-incongruent behavior while accepting negative thoughts/feelings to
advocate committed action over experiential avoidance (Harris, 2009; Hayes,
2005).
For this purpose, ACT provides six core therapeutic processes: Cogni-
tive Defusion (observing thoughts and feelings), Acceptance, Mindfulness of
the present, Understanding the Self as Context (realizing the self listens to
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thoughts/feelings but is not defined by them), Examination of Values, and

Committed Action, the latter including any form of goal setting, exposure,
behavioral activation, and skills training (Harris, 2006, 2009; Robb, 2007).
Moreover, ACT notes how attempts to control thoughts/feelings are sabo-
taged by ironic process in the same way that trying to deny one’s gender or
sexual identity may construct an anxious, self-critical closet (Cole, Kemeny,
Taylor, & Visscher, 1996; Harris 2009; Hayes, 2005; Wenzlaff & Wegner,
2000). Yet when clients defuse—when clients step back from the perceived
sense of immediacy— negative thoughts/feelings can be viewed as part of a
valid spectrum of personal experience.
Unfortunately, this sentiment may be difficult for some sexual- and
gender-variant individuals bombarded by negative messages, violent im-
agery, and homophobic zeal. Statistically, closeted gay men (Cole et al.,
1996), lesbians (Oetjen & Rothblum, 2000; Rothblum, 1990) and transgen-
der individuals are at a drastically increased risk of anxiety and depression
(Gagné, Tewksbury, & McGaughey, 1997; Gonzalez, Bockting, Beckman,
& Durán, 2012; Nuttbrock, Rosenblum, & Blumenstein, 2002; Strain & Shuff,
2011). Yet when heterosexism seems so global, recurrent, and fundamentally
traumatic, even out individuals may wrestle with internalized homopho-
bia/transphobia, shame, self-doubt, anxiety, depression, suicidal ideation,
and social alienation (Beane, 1981; Bockting, 2008; Bradford, 2004; Forstein,
1988; Igartua, Gill, & Montoro, 2003; Kurdek, 1987; Margolies, Becker, &
Jackson-Brewer, 1987; Meyer & Dean, 1998; Szymanski & Chung, 2001;
Szymanski, Chung, & Balsam, 2001).
As a racially, spiritually, and culturally diverse population of mi-
crogroups, self-acceptance within the LGBT community cannot be parsed by
issues of sexual and gender identity alone (Butler, das Nair, Thomas, 2010;
Rust, 2000, 2003; Vaccaro & Mena, 2011; Wynn & West-Olatunji, 2009). As
such, it is pertinent to view sexual- and gender-variant clients as individu-
als reacting and interacting with their own worldview, which in turn may
influence, and be influenced by, their core values and root metaphors.
 284 A. L. Stitt

In 1966, social-learning theorist Julian Rotter coined “locus of control” to

describe the level of autonomy individuals believe they have in their ability
to control psychosocial events. Individuals with an internal locus of control
(IC) feel they have direct influence over circumstances in their life, whereas
individuals with external locus of control (EC) may feel at the mercy of
environmental factors (Rotter, 1966). In 1972, Jones and colleagues coined
“locus of responsibility” to describe how individuals attribute blame, either
toward themselves or toward the larger social system. Working with racial
and ethnic minorities, Derald Sue (1978) observed internal and external
locus of control on an axis with internal and external locus of responsibility
(IC/EC: IR/ER). The permutations thereof contribute largely to an individual’s
worldview (Sue & Sue, 2008). By adapting this axis for sexual and gender
minorities interacting with hetero- and homonormative culture, therapists
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may tailor ACT techniques to address the dynamic issues facing lesbian
women, gay men, bisexuals, asexuals, transgender men (FtM), transgender
women (MtF), gender-queer androgynes, along with fluid pangender, and
neutral agender individuals.
As complex, culturally intersecting minorities coping with homopho-
bia/transphobia, any LGBT individual may reflect modes of internal con-
trol –internal responsibility (IC-IR), external control–internal responsibil-
ity (EC-IR), internal control–external responsibility (IC-ER), or external
control–external responsibility (EC-ER). Responding to the sheer diversity
of worldviews, ACT adapts, providing no singular route to self-actualization.
However, case examples are provided to demonstrate ACT for LGBT clients
struggling with locus of control, Responsibility, and their subsequent impact
on locus of acceptance, defined here as the attributed worth of internal and
external cues perceived necessary by the client to achieve self-acceptance.

ACT FOR SEXUAL AND GENDER MINORITIES

Imagine sitting outside, far from civilization, with a cat on your lap. The cat
represents all of your emotions. It purrs when it’s happy and claws when it’s
angry. It’s not good or bad— it merely reacts to life. Yet the clouds are dark,
and when it rains the cat yowls and digs its claws into your lap. Attempting
to control your emotions is like attempting to control the cat’s reaction. It’s
wet and angry, and every time you try to throw it off it only digs in deeper.
Inevitably, you can’t avoid your feelings anymore than you can outrun the
rain.
A crucial tenet of ACT is to accept the diversity of emotional experience,
not merely the positive joys (Harris, 2009; Hayes, 2005). This is not the same
as accepting bigotry or homophobia, which can be as frightening as thunder
in the clouds; but accepting the fear, anger, and shock of our own personal
reactions to it. In doing so, we relinquish the struggle to avoid or fortify
 The Cat and the Cloud 285

ourselves against negative emotions, allowing our focus to be mindful of

more than the pelting rain or the cat’s claws.
The rain, in this allegory, represents the thousands of microtransgres-
sions that build up over time, including heterosexual privilege, cisgender
privilege, male privilege, White privilege, and in the West even Judeo-
Christian privilege. A single drop wouldn’t be so bad. Even a light shower
would be tolerable, but a tempest? In such a storm, having an objective
umbrella—even if it can’t disperse the clouds—will at the very least clear the
rain from our eyes.
In ACT, the goal is not to ignore or avoid feelings, which would be
the metaphorical equivalent of trying to outrun the storm. An umbrella,
however, doesn’t keep an individual wholly dry nor resolve the issues of
our waterlogged cat. Yet it does acknowledge that it is raining, we are wet,
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and there are more options available to us than just fleeing avoidance or
tolerantly sitting in the downpour.

LGBT LOCUS OF CONTROL AND RESPONSIBILITY

Internal Control-Internal Responsibility (IC-IR)
Internal control fosters self-motivated expression. Likewise, internal respon-
sibility reflects confidence of success within the current societal framework
(Sue & Sue, 2008). Although being assertive about their own identities, LGBT
IC-IR clients may be passive about society, feeling they can make it within the
preexisting norms—which they may even adopt themselves. Such clients, es-
pecially bisexuals caught between the heterosexual/homosexual dichotomy,
may favor self-reliance, perhaps with little to no interaction with an LGBT
social network (Bradford, 2004). LGBT IC-IR clients may rather blame them-
selves than relinquish control to an outside source, remaining unaware of
their own internalized heterosexism.
Case study (IC-IR). Diana is a 22-year-old lesbian enrolled in college.
Deeming herself in control, and responsible for her own future, Diana is
highly self-motivated. However, she often dismisses how being a sexual
minority influences her feelings, avoiding her emotional reaction to being
the only openly gay woman in her dorm. Diana rationalizes her dismissal by
stating, “There’s no point in getting mad about it.”
ACT for LGBT IC-IR. Rationalizing statements such as, “I just don’t let
it bother me,” or “It is what it is” are often heard among working-class ho-
mosexuals, specifically gay men, distancing themselves from politicized gay
culture to avoid controversy (Keogh, Dodds, & Henderson, 2004). Defusion
allows clients to listen to their own thoughts without judging them. Feeling
sad or isolated does not detract from autonomy, nor does recognizing the
impact of being an individual within a system—in Diana’s case, being the
only visible lesbian in her dorm. By observing her feelings of isolation as
 286 A. L. Stitt

valid, Diana can begin to recognize the extent her social interactions have
on her cognitive schemas and emotional experience (Harris, 2009).
Solution-focused adjustments to committed action are also an excellent
way to promote self-actualization, yet equal time must be spent examining
how, unlike behavior, thoughts and feelings do not adhere to locus of control
(Harris, 2009). In short, even people in control may feel helpless and lonely.
Defusing from control efforts may grant a deeper understanding of what
Diana fairly, or unfairly, holds herself responsible for. In Diana’s case, she
dismisses what she has no control over, yet by questioning the effectiveness
of these avoidance tactics, and the perceived parity of responsibility, it is
possible to create a new paradigm of influence and self-esteem while still
remaining true to Diana’s sense of self-empowerment.
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External Control-Internal Responsibility (EC-IR)

An individual with external control is heavily influenced by dominant culture,
whereas their internal responsibility feels obligated to live up to society’s
standards (Mio, 2005; Sue & Sue, 2008). LGBT EC-IR clients may deem society
acceptable the way it is, or else feel victimized and subservient to it. Within
the LGBT community this may be reflected in two social models:

1. Dominant heterosexual/cisgender culture: Often LGBT clients employ

heteronormative camouflage out of fear, complacency, or a straight-acting
preference founded on hierarchal gender schemes (Firestein, 2010;
Martino, 2012; Rust, 1995, 2000, 2003; Szymanski et al., 2001). Feelings of
invisibility and isolation are common (Lev, 2004; Rothblum, 1990; Strain
& Shuff, 2011).
2. Dominant LGBT culture: Adhering to metropolitan stereotypes, ethnocen-
trism and homonormative body image, clients may simplify their identity
to fit in with the dominant gay, lesbian, or transgender culture (Brown,
2012; Chapman & Brannock, 1987; Devor 1997a, 1997b; Firestein, 2010;
Lev, 2004; Rust, 1995; Vaccaro & Mena, 2011; Wood, 2004). In the United
States this is typically a White, Eurocentric, gay male culture (Butler et al.,
2010; Vaccaro & Mena, 2011; Wynn & West-Olatunji, 2009). Such self criti-
cal, image conscious, homonormative adherence has been shown to be as
disabling among gay males as heterosexism (Martino, 2012; Wood, 2004).

Case study (EC-IR). Paka is a 35-year-old Hawaiian man living in

Nevada. Although openly gay, Paka is 6 feet tall, weighs 200 lbs, and is
often mistaken as a heterosexual because he doesn’t adopt the American
stereotype of how a gay male is “supposed to act.” When Paka attempts to
socialize with the LGBT community, he’s typically referred to as a “Bear”
because of his size, which Paka finds offensive as he does not associate with
 The Cat and the Cloud 287

that image scene. In the past, Paka would have stood up for himself, but
recently he’s played along because he feels not only excluded, but worthless
for not living up to social standards. Paka longs for a sense of community,
a sense of family, but feels bad for asserting his identity even among his
friends. When asked, Paka holds himself to blame for his problems, and
every time he thinks about his situation he feels either selfish or pitiful.
ACT for LGBT EC-IR. Fusing with negative self-judgments, LGBT EC-IR
clients may hold themselves accountable for not living up to perceived so-
cial norms. For Paka it may be important to compare what it means to be
selfish with the recuperative value of being self-focused, or how accepting
and asserting one’s differences may actually help his community. Notably,
individuated self-empowerment is a common Western belief, especially in
LGBT communities, yet EC-IR power dynamics may be more present within
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collectivist cultures (Berry, Poortinga, Segall, & Dasen, 1992; Gonzalez et al.,
2012; Mio, 2005; Sue & Sue, 2008). Likewise, submissive sexual personalities
may also prefer to externalize their locus of control. Understanding this, spe-
cial attention to Paka’s self schema will illustrate how his personal strengths
may, or may not, align with the expectations of the dominant culture (Harris,
2009; Sue & Sue, 2008).
Often, developing LGBT identities may fuse with the fear of being dis-
owned from their social or family system, building their agenda of emotional
control on a foundation of guilt (Lev, 2004; Savin-Williams, 2003). Because
LGBT EC-IR clients may attempt to restrict their thoughts while living in
heteronormative groups, immersion in an LGBT environment—where the
external controls emphasize self-acceptance— may be developmentally cru-
cial (Beane, 1981; Singh, Hays, & Watson, 2011). However, in Paka’s case,
maladaptive adherence to homonormative subculture may derive from his
need to belong. A committed plan of action may include investigating new
LGBT social groups where people accept him for who he is. It may also be
useful to compare Paka’s value system against his potentially incongruent
actions. If clients are unsure of how they adopted such behaviors in the first
place, illustrate how they can fuse and defuse from thoughts and feelings
they don’t actually believe (Harris, 2009). By cultivating self-awareness and
mindful living, therapists can encourage LGBT EC-IR clients to proceed with
confidence in their own personal identity while still belonging to a larger
social group.

Internal Control-External Responsibility (IC-ER)

LGBT IC-ER clients take personal control but need society to give them
a chance (Sue & Sue, 2008). Disputing social norms, LGBT IC-ER clients
may seek to change their environment. Yet when overwhelmed, cynicism
and emotional burnout may jeopardize their occupational and educational
careers (Androsiglio, 2009; Vaccaro & Mena, 2011).
 288 A. L. Stitt

Problematically, LGBT IC-ER clients may disburse responsibility. Ob-

serving this behavior through Crocker and Major’s (1989) self-protective
properties of stigma, LGBT IC-ER clients may attribute negative feedback
as homophobic/transphobic, only compare their success to members within
the LGBT community rather than the advantaged heterosexual/cisgender
community, and devalue attributes where they, or their community, fare
poorly. Furthermore, just as posttraumatic stress disorder (PTSD) clients may
employ emotional pain to feel righteous (Corrigan & Watson, 2002), LGBT
IC-ER clients may fuel passion with anger and resentment, risking zealous
heterophobia. As such it may be relevant to assess any and all personal
history with aggression and trauma.
Case study (IC-ER). Cal is an 18-year-old, Hispanic, bisexual, gender-
queer individual born biologically female. Because Cal appears androgy-
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nous, with short hair, blue jeans, and a T-shirt, Cal is often mistaken as a
tomboy or a lesbian. Cal used to be an activist in a number of LGBT or-
ganizations, openly identifying as bisexual, but has since dropped out of
school, suffering depression, suicidal ideation, and drug abuse. After cor-
recting gender pronouns their whole life, and after being disrespected by
people even within the LGBT community, Cal suffers from pervading hope-
lessness. Because Cal is estranged from their family, they feel they have to
be staunchly independent, and since Cal can’t see a way to fix the cisgender
hetero/homonormative bias, Cal has begun rationalizing suicide as a way to
end their despair.
ACT for LGBT IC-ER. Social activism is an excellent means of transform-
ing adversity into social good, yet there comes a time when every minority
advocate surveys the enormous distance left to go (Bradford, 2004). Dis-
heartened, Cal no longer enjoys even the most positive climates. As such,
it’s important to normalize their frustration while carefully illustrating the
false hope of eradicating these negative feelings by eradicating the prob-
lem (i.e., feeling better by ending homophobia/transphobia) (Harris, 2009;
Hayes, 2005). This may initially seem depressing, yet confronting the agenda
of emotional control disillusions clients to expand their awareness (Harris,
2009; Hayes, 2005).
In ACT, defusion allows clients to feel their reactions to social injus-
tice without being consumed by frustration or sacrificing their convictions
(Harris, 2009; Hayes, 2005). Obviously, clients will be bothered by prejudice.
Obviously, the rain is wet. But yelling at the clouds only achieves so much
and may distract from the amazing occurrences in a storm. Note the cama-
raderie united by a common goal. Note the growth arising from adversity.
Note how the client’s efforts deeply inspire others (Bradford, 2004; Singh
et al., 2011). Note the insights that privileged, cisgender heterosexuals will
never gain, good and bad alike.
Moreover, ask clients if they believe most transgressions stem from
innocent inexperience, ignorant fear, or hateful prejudice? Differentiating
 The Cat and the Cloud 289

rain from pelting hail highlights clients’ values in relation to their beliefs. For
example, do they believe people are fundamentally kind/good? And how
does their answer relate to their own values of kindness?
Once again, the function of ACT is not to dismiss the personal, emo-
tional, or social problem in question, but to place it in context of a whole-life
experience, allowing despair to coexist with hope, and sadness to be as valid
as joy. Reinforcing equality as a valiant and achievable goal, therapists work-
ing with LGBT IC-ER clients may, in short, need to compare how much soci-
ety affects the client with how much the client uses society to affect their self.

External Control-External Responsibility (EC-ER)

Individuals with external control and external responsibility often feel that
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the very society they are attempting to fit into is the source of all their
problems (Mio, 2005; Sue & Sue, 2008). LGBT EC-ER clients may, therefore,
struggle with coming out given their inability to motivate without external
cue.
Case study (EC-ER). Sam is a 40-year-old African American transman
who has not come-out of the transsexual closet. As a child, Sam’s father
always teased them for trying to play “boy games.” Frustrated, Sam developed
a habit of punching their own leg, leaving large bruises.
For the first half of their life, Sam identified as a heterosexual woman,
marrying at 21, and mothering two kids. Searching for answers, Sam secretly
dated a few women, yet though Sam admired their self-expression, Sam is
primarily attracted to men. At 37, Sam began changing their appearance and
drinking alcohol to sleep at night. Accusing Sam of being a lesbian, Sam’s
husband became violent, after which they divorced.
Although Sam realizes they’re a gay man on the inside, the transition
feels too extreme. Sam is afraid to use male pronouns in case their children
will disown them. Sam wishes they could stop feeling so guilty, and though
they are not currently suicidal, Sam fears what might happen if they can’t
make their anxiety go away. Ultimately, Sam doesn’t feel they can transition
without support from their family, yet at the same time Sam doesn’t want
to “shame the family.” Sam often begins sessions by stating one of the
following, “If only things were different; If only my family loved me for
who I am; If only I weren’t a freak; If my father had only respected me.”
ACT for LGBT EC-ER. At this juncture ACT asks a crucial ques-
tion. Rather than have Sam’s life be defined by heterosexism, homopho-
bia/transphobia, alienation, depression and suicidal ideation, what will it be
defined by? And is suicidal ideation, self harm, and drug use consistent with
that? (Chiles & Strosahl, 2005). Because LGBT EC-ER clients give themselves
up to social pressure, ACT shifts the client from rule governed behavior
to contingency shaped behavior guided by values (Chiles & Strosahl, 2005;
Robb, 2007).
 290 A. L. Stitt

Therapists must be aware that old trauma may reemerge to combat

the possibility of a better life because the clients’ persistent emotional pain
is the only evidence of their perpetrator’s crime (Chiles & Strosahl, 2005;
Corrigan & Watson, 2002; Zettle, 2007). For LGBT clients, such perpetrators
include specific individuals who threatened, harassed, harmed, or disowned
them, as well as the general impact of social microaggressions, the latter
being much harder to pinpoint or verbalize. For Sam, issues surrounding
their father and their ex-husband may initially surface. Yet going beyond
the most traumatic episodes may reveal seemingly small, yet detrimental
microaggressions contributing to Sam’s fear of coming-out. Sam may need to
be reminded that the function of ACT is not necessarily to forgive perpetrators
or their actions, but to learn how to forgive oneself by validating the merit of
all emotion (Chiles & Strosahl, 2005; Harris, 2009; Hayes, 2005; Zettle, 2007).
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To create new patterns of behavior, Sam may do well to review the

classic Dead Person’s Goals (Lindsley, 1968; Harris, 2009). Often, individu-
als may want to “stop feeling ashamed” or “stop being self-conscious,” yet
these goals desire nonentity. A dead man is not ashamed. A dead man is
not self-conscious. To self-actualize, one must engage in behaviors a living
person can do better than a corpse, such as talking with other transgender
individuals, or reading about gender variance, or mindfully observing all the
masculine qualities that Sam, as a trans-man, likes about themself. Notably,
for LGBT EC-ER clients, this may require special skills training to cope with
anxiety and indecision.

LGBT LOCUS OF ACCEPTANCE

As a recurrent, fluid process weighing the pros and cons of self-expression

in every new social or occupational situation (Androsiglio, 2009; Cole et al.,
1996; Horowitz & Newcomb, 2002), the coming-out process may be mod-
erated or mediated by individuals’ specific worldview, their locus of control
and responsibility interacting with their locus of acceptance.
Although internal acceptance, defined here as an embraced personal
identity, is idealized by individuated Western psychotherapy, external accep-
tance observes the deep interrelationship between self and community. To
that end, external acceptance is not defined by social acceptance (whether
the community actually accepts an individual), but the attributed worth of
external recognition to an individual’s ability to accept themselves.

Case Studies in Review

Diana. Diana emphasizes internal acceptance yet feels detached from
the LGBT community. This may or may not present as a primary issue
 The Cat and the Cloud 291

depending on how Diana values privacy, though constant self-reliance

may cultivate fatigue and social withholding. In summary, even highly
autonomous individuals may not engage in desired expressive activities,
indicating dissonance between their values and their behavior.
Paka. Although some out clients defensively emphasize self-
expression, Paka feels pressured to adhere to homonormative standards of
articulation and body image to fit in (Martino, 2012; Wood, 2004), indicat-
ing the deep tie between internal and external acceptance. Attempting to
gain validity via social visibility alone erodes Paka’s esteem and self-worth
by compromising internal acceptance (Coleman, 1982; Lev, 2004; Rosario,
Schrimshaw, Hunter, & Braun, 2006; Rosario, Schrimshaw, & Hunter, 2011).
Cal. Initially, Cal bolstered a sense of pride to counteract heterosexist
microaggressions, a potentially polarizing experience that spiraled into so-
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cial and occupational burnout, especially when coupled with cisgender and
potentially racial microaggressions (Androsiglio, 2009; Butler et al., 2010;
Vaccaro & Mena, 2011). Yet unlike Cal’s global locus of control and respon-
sibility, their locus of acceptance is compartmentalized, internally accepting
their sexuality while still desiring external social validation for their gender.
Sam. Sam’s inability to adjust correlates with internalized heterosex-
ism, minority stress, delayed integration, stressful LGBT life events (such as
losing their husband because they came out), and the complex interplay of
sexual orientation, gender, and racial identity (Butler et al., 2010; Frost &
Meyer, 2009; Lev, 2004; Rosario et al., 2011). Just as Sam externalizes their
locus of control and responsibility, their locus of acceptance is also com-
pletely external. This may prove concerning since isolated LGBT individuals
who feel unable to help themselves are most at risk of suicidal ideation, self
mutilation, and substance abuse (Finnegan & McNally, 1987; Igartua et al.,
2003; Morrow, 2004).

ACT FOR LGBT INTERNAL/EXTERNAL ACCEPTANCE

Rather than favor internal or external acceptance as a therapeutic goal, both

must be understood as complimentary systems of committed value-based
living, especially for LGBT clients coping with social visibility issues. No-
tably, as clients develop a stable LGBT identity, the perceived importance of
internal or external acceptance, or the prioritization of one over the other,
may potentially shift. Such fluidity or rigidity may depend on the developing
intersectionality of sex, gender, and cultural identity across the life span (das
Nair & Hansen, 2012).
Identity formation is ideally stabilized via identity integration, marked
by involvement in LGBT activities, positive attitudes toward LGBT identity,
comfort in disclosure, and transforming encounters with adversity into mo-
ments of positive social role modeling (Bradford, 2004; Rosario et al., 2011;
 292 A. L. Stitt

Singh et al., 2011). The actual experience of identity integration, however,

is unique to individuals’ conceptualization of self within their communal
system. Collectivistic and individualistic perspectives, along with racial and
socioeconomic marginalization, may heavily influence an individual’s locus
of acceptance by emphasizing or, conversely, deflating their personal need
for visibility and social recognition (das Nair & Hansen, 2012).
Periodically, LGBT clients may overplay external acceptance (identity
as interaction), over internal acceptance (identity as individual), yet both are
intrinsically tied routes to self-actualization. Using schema checks to compare
the client’s values against their actions allows LGBT clients like Diana, Paka,
Cal, and Sam to see where they, as complete, multifaceted individuals, fit
within a heteronormative society as well as a subdivided LGBT community.
Understanding the inherent balance between self as individual and self
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as community member, therapists can help clients work toward an applica-

ble, highly personalized plan of action. For Diana, this may include reaching
beyond the boundaries of her dorm to find an LGBT community. Paka may
need to examine his own cultural beliefs regarding sexuality to cultivate per-
sonal pride, unifying internal and external acceptance through culture and
ancestry. Cal may need to confront the harsh reality of self-alienation, for
though their gender is an integral foundation of their identity, it is not their
sole characteristic. Until they can find a relatable community, they may need
to elaborate on their social identity as a whole, building on positive interac-
tions to gain the recognition they crave. For Sam, accepting their gender with-
out judgment, as a personal experience just like any other, may normalize
their sense of being. At which point Sam may choose to come out, working
their way up to family members by first coming out to supportive friends.
Because a worldview is devised from a complex intersection of sexual,
gender, racial, and socioeconomic factors (Sue & Sue, 2008), it is possible
to gain internal/external acceptance by working within these parameters.
The goal is not, however, to actively alter a client’s worldview, or favor
one mode of control/responsibility/acceptance over another. Instead, by be-
ing mindful of thoughts/feelings, clients may address their beliefs regarding
self-acceptance, along with any behaviors discrepant with their core values,
thereby gaining a level of psychological flexibility adaptable to all forms of
dynamic personal growth (Harris, 2009; Hayes, 2005).

DISCUSSION

Although further research is required to demonstrate the effectiveness of

ACT for sexual and gender identity acquisition, ACT presents many princi-
pals potentially useful to therapists working with LGBT clients. By accepting
negative thoughts/feelings as part of a complex experiential tableau, clients
observe their own key processes, cognitive schemas, and emotional reactions
 The Cat and the Cloud 293

as part of a rich and meaningful life (Harris 2009; Hayes, 2005). Given that
self-acceptance is a key part of many LGBT identity stage models (Coleman,
1982; Lev, 2004; Rosario et al., 2006; Rosario et al. 2011), the implemen-
tation of ACT appears self-explanatory. However, understanding the LGBT
community as a diverse range of micro-groups may increase ACT’s utility.
Although sexuality, gender, race, culture, and socioeconomic status af-
fect LGBT minority experience; heterosexism remains arguably prevalent in
all Western social tiers (Butler et al., 2010; das Nair & Hansen, 2012; Forstein,
1988; Frost & Meyer, 2009; Keogh et al., 2004; Wynn & West-Olatunji, 2009).
As such, it is possible for LGBT individuals to hold any permutation of inter-
nal and external control and responsibility because of, adjunct to, or in dis-
sent from said identity structures. For example, perceptions of internal control
and internal responsibility (IC-IR) are often maintained by in-group members
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of the dominant racial culture (Mio, 2005). Such locus of control may, or
may not, be reflected amongst a homonormative in-group comprising gay
White men (Butler et al., 2010; Vaccaro & Mena, 2011). Although racism
and ethnocentrism within the LGBT community is undoubtedly detrimental
to ethnically diverse LGBT individuals (Wynn & West-Olatunji, 2009), LGBT
individuals of any racial background may, or may not, adhere to hetero- or
homonormative standards given the complexity of experiential microgroups.
Potentially, personal experience with social marginalization, albeit racism,
sexism or heterosexism, may be more predicative of an individual’s locus of
control and responsibility than race, gender or sexuality alone.
In many cases, negative interactions with the dominant cisgender, het-
eronormative culture may spur an intense range of confusing thoughts and
feelings. Without condoning heterosexism, it’s crucial for LGBT clients to
be aware of how reactions to heterosexual and cisgender privilege can fuse
with their esteem, emotional well-being, and need for community. It is also
important for LGBT clients to understand how homonormative standards
may also impact their personal locus of control and responsibility.
Furthermore, coming out does not equate de facto self-acceptance, and a
healthy integration of value-based action may aid in positive self-actualization
(Frost & Meyer, 2009; Lev, 2004; Rosario et al., 2006; Rosario et al., 2011;
Singh et al. 2011). This is especially true when defining self-actualization as
a continuous, multifaceted expansion of desire, behavior, and identity across
the life span (Horowitz & Newcomb, 2002). Diversity is key, and with each
client the way to self-acceptance is unique, though all may nurture their
feelings in the storm—like a cat, on a lap, under an umbrella in the rain.

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