Diversity Presentation

LGBT Diversity Presentation

Ask yourself...

What sort of difficulties can this group encounter in society at large and/or the therapeutic setting?

Youth

What sort of institutional barriers does this population have to contend with?

Sexual minority status increases risk for stress related to "chronic daily hassles (e.g., hearing anti-gay jokes, always being on guard)" and to more serious "negative life events, especially gay-relevant events (e.g., loss of employment, home, custody of children, anti-gay violence and discrimination due to sexual orientation)"

Institutional barriers:

• Eight of ten students had been verbally harassed at school;
• Four of ten had been physically harassed at school;
• Six of ten felt unsafe at school; and
• One of five had been the victim of a physical assault at school.
• Increased risk for suicidal thoughts and behaviors, suicide attempts, and suicide.
• A nationally representative study of adolescents in grades 7–12 found that lesbian, gay, and bisexual youth were more than twice as likely to have attempted suicide as their heterosexual peers

• lack of medical care/rights with spouse
• Estate tax when partner dies
• Marriage isn’t recognized in some states
• Can be fired for being gay
• Possible loss of housing, not being accepted by religion.
• Negative experiences in therapy may carry over (e.g. conversion therapy).

How is mental illness viewed? Is it acceptable to seek “outside help?”

What makes this group

different from other groups?

Internalizing homophobia

Negativity, stigmas, lack of definition and ambiguity

"Occurs when a lesbian or gay persons take on society's anti-gay attitudes and direct the negative attitudes towards themselves." Also "axiomatic that all openly lesbian and gay people, including members of couples, have had to counter and unlearn internalized homophobia to some extent to achieve a measure of self acceptance and form a same sex relationship. (internalized homophobia is associated with lowered self-esteem, being closeted, depression, higher levels of suicidality, increased risk taking behaviors, and mental health and substance abuse problems (Clinical Handbook for Couple Therapy p.664)"

• Address a history of victimization as a result of harassment, discrimination, and violence
• Stigma due to persons race, class, gender, religion etc...
• Internalize negative societal attitudes
• Lack of self confidence, self hatred, depression or substance abuse, as well as relationship problems
• "Relationship Ambiguity"; commitment, boundaries, and gender-linked areas
• Struggle to define how they are as a couple if there isn’t a religious or legal framework that accepts them.
• Break-ups can also seem ambiguous because of lack of legal separation or divorce.
• Seem physically committed but psychologically absent, or vice versa because of ambiguous relationships.

Remember...

• Heterosexism; even if you do it unconsciously.
• Therapists must acknowledge the issues important to the LGBT community. Like color blindness in racial discussions, dismissing these points will negatively affect therapy.

Assessment for Therapist working with LGBT:

Therapists may also assess their competency to work with LGB clients using Dillon and Worthington’s (2003) Lesbian, Gay, and Bisexual Affirmative Counseling Self-Efficacy Inventory. It is designed as a self-report measure to assess five affirmative therapy behaviors: application of knowledge, advocacy skills, self awareness, relationship, and assessment skills (Royrsicar, 2004).

What do counselors need to have an awareness/knowledge of when working with this population?

Counseling LGBT

Demographics

Strengths

Strengths

Some things to keep in mind

"Prem Game"

Which do you identify as

or identify with the most?

Lesbian, Gay, Bisexual, Transgender, Queer

What makes this group different?

Since the LGBT community is so diverse, there is not necessarily a single strength that applies to all people within it.

That said, community resources are extremely helpful. Agencies like Howard Brown and the Center on Halsted provide much needed support for the LGBT community.

Dedicated Allies are also valued and appreciated within the community.

Difficulties

• LGBT individuals are represented in all races and cultures
• LGBT youth represent between 30% and 43% of those served by drop in centers, street outreach programs, and housing programs
• Gay Marriage is legal in: Connecticut, California, Delaware, Iowa, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, Washington, and Washington D. C.
• California and New Jersey are the only 2 states that have a law banning conversion therapy
• Arkansas, California, Colorado, Connecticut, D.C., Illinois, Indiana, Iowa, Maine, Massachusetts, Nevada, New Hampshire, New Jersey, New York, Oregon, Vermont, and Washington. Florida is the only state that bans the rights for LGBT couples to adopt.
• The most restrictive states are Mississippi and Utah, where same sex couples cannot legally adopt at all. Gay people in Florida used to not be able to adopt, jointly or singly, but a Florida district court ruled that law unconstitutional

Best Practices

http://goo.gl/maps/WEzQC

Best Practices

Countertransference

• Therapist accepted, validated, or normalized the client’s sexual orientation or gender identity.
• Therapist involvement in the LGBT community that helped the client to feel understood focusing on sexual orientation/gender identity only when appropriate and being knowledgeable about or having training in LGBT issues
• Therapist positive responses to the client (e.g., validation, normalizing, and empathy) creating a comfortable and trusting environment, and self-disclosure
• Therapists respected clients’ choices about whom to come out to.
• Did not press clients to discuss sexual orientation when it was not relevant to their presenting concerns
• Were knowledgeable of transgender issues
• Provided a support system for clients during a gender transition

• Quick refresher, what is countertransference?

According to Freud, it is the therapist’s “unconscious, neurotic reaction” to the patient’s transference of emotions from important persons in their early lives, onto the therapist (Hayes et. al., 1991).

• Three skills therapists need to combat possible negative effects of countertransference: Anxiety Management, Empathy, and Conceptual Skills.

• It's important that the counselors are aware of their countertransference, especially when working with clients they do not feel comfortable with. As always, consult we needed!