A 14-year-old African American male attempted suicide by overdose when coping with sexual orientation and “labels,” as well as conflict within the family. This case contains several themes which make clinical care challenging and highlight the importance of involving the family throughout the treatment process.  Suicide threat, issues of sexual orientation and sexual minority status, and the threat of bullying and exclusion at school are all highly charged issues, straining relationships and connections of mutual understanding and support. Participants learn to use a culturally and developmentally sensitive approach in working with sexual minority adolescents and their families in family therapy.