Lesbian tomboy development occurs within a psychosexual experiential field on a continuum from childhood gender dissonance to evolutionary butch in adulthood. Through the process of integrating gender development, sexual orientation, and identity development, tomboy lesbians learn how to maintain a sense of self and organize desire within a complicated familial/socio/cultural/context. Traversing these complications usually brings adolescent and adult lesbians into therapy where they need clinicians who understand this unique course of development.
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Buysse et al. (2006) studied this question.