Queering Disability: Exploring the Resilience of Sexual and Gender Minority Persons Living With Disabilities

Abstract

This study examined the resilience experiences of 13 sexual and gender minority persons living with disabilities, using phenomenological qualitative methodology. Researchers used in-depth, semi-structured interviews and various trustworthiness standards in the study. Participants endorsed four common resilience maximizers—self-acceptance, advocacy, social support, and a plea for recognition of humanity (an aspirational resilience maximizer)—and three common resilience minimizers—fragmentation, identity concealment, and punishment. Counseling implications and future research directions are also discussed.

Keywords

LGB sexual minority intersectionality minority stress chronic illness/disability resilience

Resilience is a positive adaption to adversarial conditions, ranging from everyday stressors to significant life events (Levitt, Horne, Puckett, Sweeney, & Hampton, 2016; McConnell et al., 2018). Resilience is further described as bouncing back, succeeding against the odds (Goodley & Runswick-Cole, 2011), an ability to navigate adversity in a manner that protects well-being (Hilliard et al., 2015), and having positive mental and physical health outcomes despite serious threats to development (Frost & Meyer, 2013; Meyer, 2015). Relatedly, resilience is a stress buffering process that is distinct from coping. Whereas coping refers to the effort individuals put into adapting or responding to stress, resilience refers to a successful stress response that minimizes or avoids adverse health outcomes (Chaudoir et al., 2017; Meyer, 2015). Resilience has been explored within diverse populations, including persons living with disabilities (Hilliard et al., 2015) and sexual and gender minority (SGM) persons (Woodford et al., 2018), but not sexual and gender minority persons with disabilities (SGMPWDs; that is, lesbian, gay, bisexual, transgender, queer [LGBTQ], persons with disabilities).

SGM persons living in the United States are susceptible to higher rates of mental health concerns and psychiatric disabilities, such as anxiety, depression, substance use disorders, affective disorders, and suicidal behavior (Velez et al., 2019). Resilience ameliorates mental health disparities of SGM persons (Meyer, 2015). SGM persons experience greater health disparities, chronic illnesses, and disabilities across the life span (Conron et al., 2010; Fredriksen-Goldsen et al., 2012; Institute of Medicine, 2011); however, how SGMPWDs utilize resilience-related factors is less understood.

Relatedly, minority stress is linked to poor mental and physical health outcomes for SGM persons (Meyer, 2015; Frost, Lehavot, & Meyer 2015) and may extend to include SGMPWDs. Minority stress is based on the premise that (a) prejudice and stigma directed toward SGM persons bring about unique stressors, and (b) these stressors cause adverse health outcomes, including mental and physical disorders (American Psychological Association, 2012; Conover & Israel, 2018). Individuals with multiple minority identities, including SGMPWDs, experience increased minority stress related to having multiple marginalized identities (Meyer, 2015). Individuals who have multiple marginalized identities are particularly vulnerable to the cumulative and detrimental impact of minority stress (Balsam et al., 2011; Conover & Israel, 2018). Multiple minority stressors may leave SGMPWDs especially vulnerable to adverse mental and physical health outcomes (Balsam et al., 2011; Conover & Israel, 2018; Hilliard et al., 2015; McConnell et al., 2018), calling into question the nature of resilience for SGMPWDs. Resilience becomes important to explore because it ameliorates the impact of multiple minority stressors and minimizes adverse health outcomes (Chaudoir et al., 2017; Meyer, 2015).

Conceptualizations of resilience are not without criticism. Resilience has been conceptualized as a personal trait, outcome, and process (Fletcher & Sarkar, 2013). A broad challenge of resilience is that there is little consensus on the definitions and operationalization of the construct (Luthar et al., 2000). Another critique of resilience is that individual resilience, which is rooted in Western ideology, exalts personal triumph over adversity, and is touted as the essence of resilience (Hobfoll, 1990). This definition implies that resilience is innate and immutable. However, such ideology can lead to negative health outcomes for historically underrepresented populations because, despite our thinking of resilience as a personal attribute, not everyone has the same opportunity for resilience when underlying sociocultural systems are unequal (Meyer, 2015). As Merton (1957/1968) noted, the opportunity structure—the social, economic, and political structures that make success possible in society—is not equally distributed. Thus, a Western view of individual resilience does not consider the systemic oppression faced by marginalized populations. Without acknowledging the contextual factors: power, privilege, and systemic oppression (homophobia, ableism [a system of discrimination against and oppression of people with disabilities], racism, sexism, and socioeconomic inequality), some individuals may come away with feelings of personal inadequacy and ineffectiveness.

Despite these critiques of resilience, scholars suggest the need to consider resilience strategies used to reduce the risk of harmful physical and mental health outcomes (Conover & Israel, 2018; Hilliard et al., 2015). The protective nature of resilience and its ability to mitigate the detrimental impact of multiple minority stress on SGMPWDs make it important to study (Hilliard et al., 2015; Levitt et al., 2016; McConnell et al., 2018). Moreover, scholars have called on researchers to move away from solely discussing risks faced by intersectional populations to examining protective factors, such as resilience, to more comprehensively address health concerns (Asakura, 2017; Kwon, 2013; Meyer, 2015; Remedios & Snyder, 2015). The strength-based focus of this study is important because understanding the resilience experiences of SGMPWDs has the potential to promote opportunities to better support the growth and development of SGMPWDs. Thus, the purpose of this study was to examine the lived experiences of SGMPWDs. More specifically, the analytic research question guiding this study was as follows:

Research Question: How do SGMPWDs define, understand, experience, and describe their lives?

Method

Participants

In total, 13 individuals between 24 and 52 years of age (M age = 35) participated in this study. Participants identified as lesbian (n = 3), gay (n = 3), bisexual (n = 3), queer (n = 1), and pansexual (n = 2). One participant, a transgender man (n = 1), married to a cisgender woman, identified as heterosexual. Racially, participants identified themselves as Black or of African heritage (n = 4) and White (n =9). Although participants endorsed a variety of disability types, the clear majority (n = 9) indicated having a physical disability that affects motor/mobility. Appendix Table A1 lists participant’s pseudonyms, sexual and gender identity, disability, age, and race/ethnicity.

Research Team

The research team included five members: one counselor educator, three doctoral students in counselor education, and one master’s student in clinical rehabilitation counseling. The lead researcher identifies as an African American, queer, cisgender woman, who has a lifelong physical disability. Her own experiences as a sexual minority person living with a physical disability underscored her interest in initiating this study. Additional researchers include a gay, European American, cisgender man; a Blaxican (i.e., Black and Mexican), cisgender woman who has a parent with a physical disability; a White, cisgender, able-bodied woman; and an African American, cisgender, heterosexual man who has an acquired disability.

Research team members met frequently to reflect on and examine individual subjectivities that may affect the collection and interpretation of the data (Creswell et al., 2007; Moustakas, 1994; Singh et al., 2011). Subjectivities included (a) an awareness and knowledge of issues affecting SGMPWDs, as well as contextual and historical events; (b) firsthand experience living with disabilities; (c) socialization experiences related to disability, sexual orientation, and gender identity; and (d) the potential for making uninformed or microaggressive statements. As part of a reflexive approach, the team met frequently to debrief, bracket, and examine our subjectivities during data collection and analysis phases; we recorded the notes from the bracketing meeting as part of qualitative journaling (Creswell et al., 2007).

Research Methodology

Qualitative research methodologies empower individuals to share their stories in their own terms (Creswell et al., 2007) and can accommodate the richness and complexity of marginalized experiences (Else-Quest & Hyde, 2016a, 2016b; Ghabrial, 2017). Phenomenology, a qualitative methodology (Creswell et al., 2007; Moustakas, 1994), was used for this study because we were seeking to understand the essence and meaning of resilience among SGMPWDs. An intersectional framework, rooted in Black feminist thought (Collins, 1990; Crenshaw, 1991; Hooks, 1984; Lorde, 1984), informed our use of phenomenology. Intersectionality theory explicates the power structures within systems of oppression experienced by SGMPWDs and provides a crucial lens for understanding experiences of multiple marginalization (e.g., discrimination, stigma, microaggressions, prejudice, privilege, and oppression) and their relationship to health outcomes (McConnell et al., 2018; Meyer, 2015). Intersectionality theory avows that multiple marginalized identities construct novel experiences that are distinctive and not divisible into their component identities and experiences (Bowleg, 2012; Purdie-Vaughns & Eibac, 2008). Intersectionality’s emphasis on the fundamental interconnections between systems of oppression is at the heart of its contribution and utility for transformative, emancipatory social change. Scholars have called for more intersectional research, moving away from examining single-axis identities and incrementally increasing needed scholarship on multiple minority stress and resilience (Remedios & Snyder, 2015).

Data Sources

Demographic questionnaire

Participants completed a demographic survey that included age, gender identity, sexual orientation, relationship status, race/ethnicity, educational level, disability status and onset, employment, socioeconomic status, and income.

Semi-structured interviews

The semi-structured interview protocol was grounded in the relevant literature on resilience and SGM persons living with disabilities. The first author drafted a set of interview questions that the research team reviewed. The first author subsequently modified the interview questions throughout the study, based on the team’s feedback. Sample interview questions included the following: What do you want people to understand about your life as a sexual minority person with a disability, and please describe the strengths you possess that help you deal with stress in your life?”

Procedure

An institutional review board from a large research university in the southeastern United States approved all procedures for this study prior to data collection. Advertisements for the study were sent to internet-based message boards that support SGMPWDs. Participants were required to affirm that they were (a) 18 years of age or older, (b) a member of the sexual and/or gender minority community, and (c) a person living with disability. For this study, the term “disability” is broadly defined, to include chronic illnesses. Purposeful snowball sampling procedures were also utilized, allowing for the selection of information-rich cases related to the phenomenon of interest (Grbich, 2013).

Researchers used electronic communication to invite potential participants to respond voluntarily to an online demographic survey administered using Qualtrics. Individuals were provided an electronic informed consent form before proceeding with the online survey. At the end of the questionnaire, participants had the option to volunteer for an individual face-to-face or telephone interview with the primary researcher. To accommodate geographic distances and those participants whose disabilities precluded them from driving, the primary researcher interviewed all 13 participants via telephone and obtained verbal consent to continue the interview. All interviews were audio-recorded and then transcribed verbatim. Interviews lasted between 60 and 75 min.

Data Collection and Analysis

Data analyses followed an idiographic process, germane to phenomenological methods. The research team examined the experiences of the first two participants, looking for similarities among new participants interviewed for this study (Grbich, 2013). The research team coded the transcripts line by line, pulling essential meaning units of one word or a whole sentence (Creswell et al., 2007). In the second step, the research team met for consensus coding of the first two interview transcripts to further reduce the data into meaningful phrases that described the phenomenon, resilience. We then identified codes and clustered them by themes, with examples of raw data illustrating the related theme in the transcript. This process led to the creation of a preliminary codebook, which we used to guide the analysis process for subsequent interviews. Approximately 39 main codes, 28 sub-codes, and two sub-sub codes were identified in this process, and all were included in the initial codebook.

The first author interviewed other participants, transcribed interviews verbatim, and completed member checks. The research team then reviewed and applied the codes devised in the initial codebook to the third, fourth, and fifth interviews. Approximately 10 new sub-codes emerged during the process, and we then revised the codebook. After applying codes to the sixth, seventh, eighth, and ninth interviews, the research team condensed analytic codes into meaningful themes and subthemes. No codes were eliminated. We identified seven main themes and 28 subthemes. We then revised the codebook again. After analyzing the final four interviews and identifying no new codes, we compared themes from all interviews and assembled them together as subthemes, identifying higher order categories (superordinate themes; Grbich, 2013). We reviewed clusters to identify broad, overarching themes that connected and collapsed codes under higher order categories. Throughout the recursive and reflective analytic process, we related themes to the primary source material and finalized the codebook. To confirm all findings, we recoded all 13 interviews using the final codebook that consisted of all final superordinate themes and subthemes.

Methodological Integrity

First, we used member checking (Creswell et al., 2007) to help establish trustworthiness. The primary researcher sent transcripts to participants to solicit their feedback as partners in the process; none of the participants provided corrective feedback or added to their narratives. At the conclusion of data collection and analyses, we sent the final codebook to all participants for feedback. Second, we employed investigator triangulation (Creswell et al., 2007) to further establish trustworthiness by having a minimum of three research team members independently code data and then meet as a group to discuss findings. We addressed inconsistent findings between coders during a consensus seeking process, with the goal of reaching full agreement among all coders; the first author led all process meetings. Other forms of ensuring trustworthiness included bracketing assumptions and biases by employing the use of memos (which became an essential data source), journaling (Creswell et al., 2007), and analyzing negative case examples. As an example, researchers assumed that both sexual and disability identity development (and the intersection of those identities) would be a key element in the development of resilience for all participants. To address this bias, researchers thoroughly examined the data for experiences where the development of resilience was not linked to identity development.

Results

Participants framed resilience as overcoming adversity and bolstering intrapersonal strength in the face of life stressors. Participant definitions included “overcoming hardships,” “bouncing back from adversity,” and “strength in the face of adversity.” Adverse events included the death of a loved one, a failed romantic relationship, a job or home loss, familial health concerns, or familial discord. The research team interpreted the majority of participants’ (n = 10) lived experiences of resilience in terms of both maximizers and minimizers. Participants described maximizers to resilience as experiences, individuals, or organizations that helped them to develop or maintain resilience. Participants endorsed four common maximizers: (a) self-acceptance, (b) advocacy, (c) social support, and (d) a plea for recognition of humanity. Conversely, participants defined minimizers to resilience as experiences, individuals, or organizations that minimized their development and maintenance of resilience. Participants endorsed three common minimizers: (e) fragmentation, (f) identity concealment, and (g) punishment.

Resilience Maximizers

Resilience maximizers were experiences, approaches, individuals, and organizations that fortified the maintenance and development of resilience and were supportive of SGMPWDs’ identities. Resilience maximizers were further described as affirmative attitudes and actions that were compassionate, accepting, validating, nonjudgmental, and strength-based.

Self-acceptance

Participants (n = 9) described self-acceptance as an essential resilience maximizer. Participants shared that while they could not control the ways society perceived them, having positive beliefs about themselves helped them deal with stress and adversity, despite the ableism and homophobia they experienced. Participants mentioned that learning about their disability and their SGM identity aided in the development of self-acceptance. For example, Uni described her development of self-acceptance by saying,

I initially internalized some of that [negative stereotypes about her queer and disability identities]. It was hard for me to unlearn. Now, I am unapologetic and who I’m authentically meant to be. I’m not going to internalize whatever harmful things they’re saying or doing to me.

Uni candidly shared her frustration with “constantly” being told her disability would prevent her from achieving much of what she wanted in life. For Uni, “the final straw” was being told (erroneously) that her disability would prevent her from having children. After speaking with her physician (who dispelled many of the misconceptions she held about her disability, including clarifying that she could have children if she chose), she found self-acceptance.

Similarly, Red began her process of self-acceptance after learning more about her sexual identity by finding a label she felt best described it: pansexual. Red shared, “Having labels, there’s a sense of power to it. There’s a word that explains what I feel. It validates it. I was then able to embrace it [her pansexual identity]. It’s freeing, I feel complete as a person.” Participants noted that learning more about potential ways to identify and receiving clear, objective information about their disability ultimately led to greater self-acceptance. Self-acceptance served as a buffer against the internalization of harmful experiences and as a significant resilience maximizer.

Advocacy

Participants (n = 8) indicated that advocacy was an essential resilience maximizer. Participants noted that helpful activities included having someone advocate for physical accessibility, educational accommodations, and mental health counseling services as important ways to build resilience. Participants also reported educating themselves and others about LGBTQ and disability issues, becoming active in affirming disability and LGBTQ social justice organizations, as well as engaging in self-advocacy as resilience strategies.

Jack, a transgender man living with learning and anxiety disorders, identified his parents as his first advocates. Jack recalled attending an Individualized Education Plan (IEP) meeting (a goal planning meeting for students with disabilities in high school) with his mother. He said,

Folks tried to talk solely to my mother. She said, no, talk to him. She then said to me, “These are decisions about your life. You take control over it . . .” That was my first example of advocacy.

Jack said his mother’s example not only taught him to self-advocate but to advocate for others. He explained, “I don’t do ‘visible’ things. I advocated for unisex restrooms so transgender students could use them safely.” He also changed his department’s hiring forms to accommodate preferred pronouns. Whether participants had someone to advocate for them, or they advocated for themselves, both advocacy and self-advocacy were noted as essential resilience maximizers for SGMPWDs.

Social support

Participants (n = 11) identified connections with sources of social support as another significant aspect of their resilience. Social support consisted of individuals, advocacy organizations, social media and other online platforms, as well as biological family and/or close friends, whom some participants refer to as “chosen family.” Zee, who identifies as bisexual, said she found support for her sexual identity through a group of women friends she came out to as an undergraduate student. She stated,

I initially identified as a lesbian. My friends were very supportive. Others would say, “She’s a lesbian?! I know she came on to you then!” But my friends shut down those stereotypes. They had my back. I’m still friends with these young ladies. I really appreciate them.

Another participant, Erica, endorsed having social support as a resilience maximizer. Erica, who was previously married to a man, recounted a devastatingly painful experience she endured after coming out to her then-husband. She shared that when her former mother-in-law learned her sexual identity, she filed for and gained custody of Erica’s children. The judge ruled that Erica was “an unfit mother” due to her sexual orientation. Erica’s experiences may illuminate systemic inequities faced by SGMPWDs. Despite these difficulties, Erica, who now identifies as a lesbian and is legally married to a woman, echoed sentiments similar to several participants about her social support system. Erica eventually connected with the lesbian community. She shared,

My community has played a great role because they’ve been very supportive and understand how I feel. They respect my marriage, me as a parent, worker, and friend. My life is not defined by who I love. I have been blessed to be around those people. My community is a source of support, encouragement, and affirmation.

Clayton spoke about finding support related to his disability through disability organizations that provided a variety of tangible resources, such as rehabilitative therapies and related services:

As far as my disability goes, the community impacted it a lot when I was younger because I was involved in so many organizations, and I went to an early intervention program, which was geared toward individuals who had disabilities. They offer services like physical therapy, occupational therapy, speech therapy, so, it played a huge role.

Like Clayton, several participants identified social support through involvement with disability and LGBTQ-affirming organizations, while others identified social media platforms as a source of support developed by connecting to other SGMPWDs online. SGMPWDs’ access to social support functions as a resilience maximizer and is a testament to the resilience found within these communities.

Plea for recognition of humanity

Participants expressed feeling frustrated with not being viewed as adults who were worthy and capable of maintaining occupational, sexual, and romantic relationships (n = 12). Participants discussed how people with disabilities are viewed as an amorphous group that cannot and should not exercise personal agency. Furthermore, non-SGMPWDs often perceived them as eternally childlike and angelic. Participants resoundingly characterized these experiences as serious threats to resilience and unvaryingly issued a plea for the recognition of their humanity. Uni articulated, “Disability is not a monolith. People with disabilities are sexual and worthy of love, compassion, and intimacy, and all the good things that come with life.” Given their frustrations, when asked what he wanted people to understand about being an SGMPWD, Clayton said, “I don’t want people to turn away because of my disability or my sexuality. I want them to get to know me as a human being first.” Red explained,

You can be both a sexual minority person and a person who has a disability. Having a disability and being a member of the LGBTQ plus community is intertwined. Being a queer person and a disabled person—we just want to be seen.

The seemingly simple desire to be viewed as “fully” human may reflect the pervasive and harmful nature of prolonged exposure to multiple minority stress resulting from experiences of ableism, homophobia, and racism. Participants confided that prejudice, stigma, and discrimination negatively affected all areas of their lives. For example, participants reported that the multiple minority stress they experienced, based on their sexual, gender, and disability identities, caused difficulty in finding suitable employment, locating romantic partners, securing accessible housing, and finding accessible transportation. Despite significant challenges, they continued to find creative ways to survive and thrive, or “bounce back,” when faced with adversity and intersectional oppression.

Resilience Minimizers

Resilience minimizers were identified as experiences, individuals, events, or organizations that did not support the development and maintenance of resilience.

Fragmentation

Participants’ experiences with the perpetual fear that one or more aspects of their identities would not be welcomed or accepted resulted in fragmentation. Most participants (n = 9) endorsed fragmentation as a resilience minimizer. Participants voiced feeling they could only express pieces of themselves or fragments. Rain explained, “My biggest stressor is feeling like you have to sacrifice one aspect of your identity because of the other. In my family, I have to sacrifice my sexual identity because I need help due to my disability and illness.” Participants shared feelings they could not fully express themselves or share all their identities in any setting or context, even with family. The fragmentation theme elucidates participants’ experiences with a lack of belonging, where the importance of their intersectional perspective was not recognized and/or was silenced. In either case, participants described feeling only parts, or fragments, of their identities were seen and acceptable. Shona articulated the following:

I experience queer-phobia from the disability community and ableism in the queer community. When I am in disability spaces, people say, We aren’t talking about that “gay stuff” right now, just disability. When I am in queer spaces, they are usually inaccessible. If the space is physically accessible, I get stared at and asked, “Why are you here?”

Shona expressed frustration with having no place where she could be her “full self” without experiencing microaggressions based on disability, race, sexuality, or at the intersection of those identities. Shona illuminated the fragmentation theme by noting the seeming desire of others to silence her perspective as a sexual minority person in disability spaces and as a person with a disability in LGBTQ spaces. In addition, Shona also contended with two forms of ableism, physical inaccessibility and attitudinal barriers. First, in the physical environment, architectural barriers (e.g., stairs or inoperable elevators) make spaces unwelcoming and physically inaccessible. Second, attitudinal barriers are inherent in the question, “Why are you here?” This question conveys that people with physical disabilities are not welcomed. Another participant, Zee, said,

In college, I initially identified as a lesbian. I remember someone remarking, “She’s Black, so she already has a strike against her. She’s a woman, so she has another strike against her, and she has a disability, so that’s yet another strike against her. Why would she want to be a lesbian?”

Due to several heart wrenching experiences like this one, Zee began to conceal her bisexual identity, an approach endorsed by a smaller number of participants.

Identity concealment

“Coming out” is broadly seen as a rite of passage for SGM persons. However, coming out is not always safe socially, physically, and/or financially, particularly if you have multiple marginalized identities, like SGMPWDs. Therefore, several participants (n = 3) discussed concealing aspects of their identities to protect themselves. As a result of their disabilities, many SGMPWDs relied on family or community members to assist them in completing activities of daily living (ADLs; for example, driving, grooming, eating, toileting), so coming out could lead to dire consequences.

After having many painful experiences, Zee shared that though she was unable to hide her physical disability, she could hide her bisexual identity. She concealed her sexual identity for fear of experiencing more “biphobia.” Zee explained that she did not disclose her bisexual identity to potential partners until a level of trust developed, to ward off the stereotype that commonly accompanies the bisexual identity—that she “sleeps with everyone.” Zee candidly shared that she did not feel “whole” because she feels forced to hide her sexual identity. Zee said she would like to talk to her sister and mother about her romantic interests, but that her mother and sister were “too religious” and did not approve of her bisexual identity. Another participant, Tina, described her experiences:

Either I’m supposed to downplay my disability and up my level of queerness, or I’m supposed to downplay my queerness and up the disability. I can exist in both places [can be both a sexual minority person, and a person who has a disability]. I can, and I do!

The majority of participants echoed the sentiment that the expectation that they downplay certain aspects of their identity, whether it be disability status, or sexual and/or gender identity, functioned as a resilience minimizer.

Punishment

Participants (n = 6) described insidious and harmful forms of intersectional oppression that were directly linked to the intersection of their ability and sexual minority identities. Punishment, a novel finding, was described as the deliberate removal of financial, familial, and/or social support and resources as a result of a sexual and/or gender identity disclosure, with the understanding that doing so would likely harm the participants’ mental and/or physical heath. Unlike fragmentation, punishment not only involved simply ignoring or silencing intersectional perspectives, but it also entailed direct, deliberate actions intended to cause harm as a show of disapproval. For those participants whose disability prevented them from working or that necessitated assistance with ADLs (e.g., driving, eating, grooming, toileting, and cleaning), the discovery of their sexual and/or gender identity could have dire consequences. For example, Rain discussed the degenerative and life-threatening nature of her disability. She shared that as her condition worsened, she was forced to stop working and to move back in with her parents. After learning that Rain was in a same-sex relationship, her parents threatened to stop taking care of her physically, as well as financially. Rain movingly shared:

I can’t be in a relationship or do any of these things because I do need help, and I must choose. What do you choose? Do you choose being happy in a fulfilling relationship with someone you really care about, or do you choose being able to physically survive, to live?

In Rain’s case, the decision to choose “being happy” by being romantically involved with a same-sex partner could literally be a matter of survival.

Clayton explained how his grandfather used punishment upon learning his identity as a gay man. He said, “I live with my grandparents and rely on them for transportation, due to my disability. Since I came out, my grandparents have refused to transport me anywhere, even to job interviews, for fear of me going on ‘homosexual dates.’” Clayton’s grandfather’s reaction, and subsequent withdrawal of transportation assistance, limited Clayton’s ability to secure gainful employment in a timely manner. Rain’s and Clayton’s experiences demonstrate how the intersection of ability and sexual minority status produced intersectional forms of oppression (i.e., simultaneously experiencing homophobia and ableism) and subsequently punishment.

Discussion

The aim of the present study was to understand how 13 SGMPWDs described their lived experiences of resilience, using a qualitative phenomenological approach with a critical intersectional framework. Participants framed the meaning of resilience as “bouncing back” from difficult circumstances and “overcoming hardships.” Participants conceptualized resilience, similar to other study findings (Levitt et al., 2016; McConnell et al., 2018; Meyer, 2015), as a set of learned behaviors and the presence of social support that fostered their ability to “bounce back” or to “avoid giving up” when faced with hardships and adversity.

Participants in this study described their lived resilience experiences in terms of maximizers and minimizers. A maximizer, self-acceptance, allowed participants to draw on positive beliefs about themselves to address multiple minority stressors. Fostering positive self-esteem and LGBTQ pride promoted greater self-acceptance and lower levels of psychological distress (Woodford et al., 2018).

Social support consisted of individuals, organizations, social media platforms, family members, and close friends that affirmed and advocated for and with participants. These findings are consistent with previous scholarship on the importance of social support for SGM persons (Conover & Israel, 2018; Meyer, 2015; Singh, 2011). Participants acknowledged difficulty finding communities that affirmed both their sexual minority and disability identities, particularly those grounded in social justice and advocacy. Despite this, both advocacy and self-advocacy remained essential resilience maximizers. These results emphasize the importance of locating affirmative communities and organizations that actively engage in intersectional social justice work.

The research team discovered another novel and compelling finding—that the plea for the recognition of humanity acted as an aspirational resilience maximizer. Almost uniformly, participants said they wanted people to know that SGMPWDs exist and are fully capable and desirous of meaningful occupational, familial, affectional, and social lives. The responses seemed to rebuke systems of intersectional oppression (e.g., ableism, racism, homophobia) and the challenges they faced due to resilience minimizers: fragmentation, identity concealment, and punishment.

Participants’ experiences also reflect the detrimental impact of fragmentation. Fragmentation elucidates participants’ experiences as marginal members within marginalized groups, relegating them to a position of acute invisibility. As a resilience minimizer, fragmentation reflects earlier literature on intersectional invisibility (Purdie-Vaughns & Eibac, 2008). Intersectional invisibility posits that people with multiple marginalized identities are negatively affected because they are not prototypical of either group of which they are a member, rendering them invisible and silenced. For example, an African American, lesbian woman, living with a physical disability is not the societal ideal for any identity groups to which she belongs, whether based on race, sexuality, sex, or ability status. Each of her identities is marginalized and is subject to stereotyping, misrepresentation, marginalization, and disempowerment. From an intersectional perspective, a variety of oppressive systems (e.g., ableism, homophobia, racism, sexism) combine to create unique experiences of interlocking oppression.

Furthermore, SGMPWDs are members of marginalized groups and face the burden of having their concerns seen as “too complicated” or too narrow (Purdie-Vaughns & Eibac, 2008). This means, multiple marginalized persons may not have the benefit of using already established and resourced organizations, as they are expected to develop their own (Purdie-Vaughns & Eibac, 2008). Furthermore, even purportedly inclusive organizations assume another organization will address the needs of multiple marginalized populations. For instance, participants noted that LGBTQ organizations assume disability organizations will address the needs of SGMPWDs and vice versa, a misconception that leaves SGMPWDs socially, politically, and economically unheard, invisible, and further marginalized. Multiple marginalized persons like SGMPWDs are aware that their perspectives are often ignored and dismissed, along with some aspects of their personhood and identities (Remedios & Snyder, 2018).

Identity concealment is likely a protective response and adaptation to resilience minimizers. The broad assumption that “coming out” is an identity imperative for SGM persons does not fully consider the potential implications for multiple marginalized persons. While the coming out narrative may be representative of White, relatively affluent, gay men, it is not culturally appropriate for all groups (Purdie-Vaughns & Eibac, 2008). For example, an economically disadvantaged, Black, gay man may be dependent on heterosexual family members for financial support. Those family members may be religious and unsupportive of his gay identity, so coming out may pose the risk of punishment in the form of alienation from familial, economic, and social support. Moreover, the four participants of African and Afro-Latin descent reported instances of racism in addition to ableism and homophobia, which added greater complexity. Participants confided that dealing with intersectional forms of oppression made them feel more vulnerable. When confronting racism (in contrast to homophobia and ableism), they could connect with family members that endured similar forms of racial discrimination, which provided an avenue to learn and to garner support. Conversely, disclosing their sexual identity could have the opposite impact, causing them to lose familial support.

Similarly, punishment represented an extreme reaction to participants’ disclosure of sexual and/or gender identity. Punishment differed from fragmentation in that sexual minority persons’ perspectives were not simply ignored or silenced. Punishment consists of deliberate actions taken (e.g., withdrawal of transportation, financial, social, residential, and/or personal care) as a consequence of disclosure. These withdrawals of resources and support pose harmful, even dire, consequences and present a significant threat to the mental and physical health and development of SGMPWDs.

Counseling Implications

Rehabilitation counselors should assess resilience minimizers and bolster resilience maximizers when working with SGMPWDs. As self-acceptance functioned as a resilience maximizer for participants, rehabilitation counselors should evaluate, support, and affirm a client’s sexual, gender, and disability identities, to promote greater client self-acceptance. Identity development is essential to fostering self-acceptance, so rehabilitation counselors should seek training and supervision regarding disability and sexual minority concerns, to include reviewing critical disability identity literature (see Forber-Pratt et al., 2019) and learning more about the Affirmative Intersectional Rehabilitation Counseling Model and other counseling practices that support the unique needs of SGMPWDs (see Dispenza et al., 2016, 2017).

Social support and advocacy were noted as significant resilience maximizers. Rehabilitation counseling professionals are uniquely qualified to support the needs of SGMPWDs as we routinely engage in advocacy efforts, help clients develop self-advocacy skills, and provide information and referral services. Thus, rehabilitation professionals are well positioned to help clients identify sources of social support and to advocate with and for them. Also, because social justice and advocacy is considered the “fifth force” in counseling and is a professional imperative (Ratts et al., 2016), counselors should develop and maintain a verified list of identity-affirming resources for SGMPWDs. In cases where there are limited community resources or advocacy organizations (e.g., rural areas), counselors can advocate for the needs of SGMPWDs and educate the community about the many forms of marginalization these populations face. While these approaches are not a substitute for training, these resources can help counselors identify and promote the development of resilience strategies among SGMPWDs.

Findings from this study also illuminate some distinctive multiple minority stressors faced by SGMPWDs. Fragmentation, identity concealment, and punishment were specific unique multiple minority stressors that affected the participants in this study and served as resilience minimizers. Given this, rehabilitation counselors should avoid presuming which identities are most salient for clients and that “coming out” is a primary goal. Instead, rehabilitation counselors should broach these topics early and with intention.

Finally, from a multicultural perspective, disability is another facet of diversity. Rehabilitation professionals have an opportunity to engage in social justice work at the individual level during the clinical encounter, as well as at the organizational and societal levels. Counselors who seek greater understanding of the discrimination and prejudice faced by multiple marginalized communities, like SGMPWDs, can help uncover some of the underpinnings and impacts of ableist attitudes and behaviors (Perrin, 2019). Therefore, counselors should familiarize themselves with the Disability-Related Counseling Competencies (Chapin et al., 2018) and the 2016 Multicultural Social Justice Counseling Competencies (Ratts et al., 2016). These resources provide an important theoretical base to help rehabilitation counselors better understand disability identity (Perrin, 2019) and to identify affirmative intersectional counseling approaches.

Limitations and Future Directions

Results of this study must be considered within the following limitations. First, developmental disabilities that primarily resulted in physical disabilities represented the disability category for most participants; therefore, the sample is not representative of the wide array of diversity within the disability community. In addition, most participants identified as cisgender, except for one participant who identified as a transgender man. Second, most of the participants (n = 9) had obtained higher education degrees or had attended some college-level courses. Thus, members of the sample have attained more education than the general population. Third, participants self-selected to be a part of the study; therefore, the experiences of those who did not answer the research call are not represented in the study. Fourth, participation was limited to those who had access to internet connection. Future research should include more racially diverse samples of SGMPWDs with varied identities to more broadly reflect the unique characteristics of these communities. Finally, although we used several forms of member checking, our findings were restricted to a one-time phone interview. It is possible to gather additional rich data through additional interviews with the same participants.

This study has important implications for future research. Study participants consistently described experiencing stigma, prejudice, and oppression at the intersection of their disability, sexual, gender, and, many times, racial identities. Painful experiences steeped in ableism, homophobia, and racism were reported during initial and follow-up interviews. Therefore, additional research on multiple minority stress and SGMPWDs could provide further insights. In several cases, participants noted experiencing ableism in the sexual minority community and homophobia, and homophobia in the disability community. Thus, more research on fragmentation, intersectional invisibility, and other forms of marginalization experienced by SGMPWDs could yield important information for mental health professionals. Another area of further study is with people of color at the intersection of SGM status and disability. Four participants, each of African descent, reported experiencing additional stigma based on race.

Conclusion

As members of various communities, SGMPWDs encompass a myriad of diverse identities and often face multiple marginalization from well-intentioned individuals who inadvertently cause harm. The results of this study provide some insight into the experiences of SGMPWDs that both maximize and minimize resilience. Given the impact of psychological well-being on personal and professional growth, and on the overall healthy development of SGMPWDs, we hope to better understand their lived resilience experiences. Furthermore, we hope this study can inform the design of mental health interventions to promote optimal mental and physical health outcomes among SGMPWDs.

Footnotes

Appendix

Table A1.

Participant Demographics.

Pseudonym	Gender	Sexual identity	Chronic illness/disability	Age	Race/ethnicity
1. Uni	Cisgender	Pansexual^a	Developmental disability	32	Biracial
2. Clayton	Cisgender	Gay	Developmental disability	33	White
3. Zee	Cisgender	Bisexual	Arthrogryposis	37	African American/Black
4. Red	Cisgender	Pansexual	Developmental disability	28	White
5. Erica	Cisgender	Lesbian	Lupus, heart failure	50	African American/Black
6. Frek	Cisgender	Bisexual	Developmental disability	41	White
7. Rain	Cisgender	Queer^b	Disc disease/depression	29	White
8. Jack	Transgender	Hetero	Learning disorder/anxiety disorder	24	White
9. Lena	Cisgender	Lesbian	Developmental disability	52	White
10. Tomi	Cisgender	Gay	Developmental disability	25	White
11. Shona	Cisgender	Lesbian	Developmental disability	26	African American/Black
12. Marc	Cisgender	Gay	Learning disability	42	White
13. Tina	Cisgender	Bisexual	Osteogenesis imperfecta	41	White

Pansexual denotes an individual attracted to someone of any sex, gender, or gender identity (ALGBTIC LGBQQIA Competencies Taskforce, 2013). ^bQueer denotes an individual whose identity is outside of heteronormativity and gender binary (ALGBTIC LGBQQIA Competencies Taskforce, 2013).

Acknowledgements

A warm thank you to Rafe McCullough, Ph.D., LPC for his contributions to this article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Tameeka Hunter

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