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Group Counseling with LGBT Clients

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Kelly Jones

on 5 December 2013

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Transcript of Group Counseling with LGBT Clients

Group Counseling with LGBTQ Clients
Presentation Overview
Trends in Counseling LGBTQ Clients
Group vs. Individual Therapy
Yalom's Factors
Counselor Preparation
Pre-Group Interviews
Establishing Group Structure
Issues that May Surface
Special Populations
HIV+/AIDS Clients
Transgender Clients
New Directions and Things to Consider
Trends in Counseling LGBTQ Clients
Prior to the movement towards supportive and affirmative groups, most group counseling for LGBTQ clients was geared towards identity changing
Clients were encouraged to renounce homosexual tendencies and make more of an effort to fit in with heterosexual society

Group counseling began to move away from conversion therapy and instead focused on process groups designed to promote identity development, self-esteem, and pro-social behavior

To avoid confusion about the direction of the group, counselors should specify that identity development groups are NOT conversion therapy!
Group vs. Individual Therapy
Counselor Preparation
Counselors must:
Be aware of their own internal homophobia, heterosexism, or biases

Educate themselves on LGBTQ issues

Do counselors need to be LGBTQ themselves?
Arguments for yes:
Heterosexual counselors cannot fully understand what LGBTQ clients are experiencing
Arguments for no:
Heterosexual counselors can promote tolerance and act as a buffer between the group and society
What the research shows:
Leaders' orientation is not necessarily indicative of group processes and outcomes; personal characteristics and facilitation style have greater impact

Coleader model is advised
Yalom's Factors
Instillation of Hope
Imparting of Information
Corrective Recapitulation of the Primary Family Group
Development of Socializing Techniques
Imitative Learning
Interpersonal Learning
Group Cohesiveness
Existential Factors
Pre-Group Interviews
Developing a LGBTQ-Affirmative Identity
Establishing Group Structure
Group structure has an important impact on group outcome

Outlining the structure prepares members for what to expect and allows the counselor to plan ahead

However, flexibility is still required
Based on the Sexual Identity Formation model (Cass, 1979; 1984)
Framework adapted for the personal and professional growth of LGBTQ-affirmative counselors
6 Stages
Stage 1: Identity Confusion ~~ Unawareness
Stage 2: Identity Comparison ~~ Uncertainty
Stage 3: Identity Tolerance ~~ Increased Disclosure
Stage 4: Identity Acceptance ~~ Risks and Activism
Stage 5: Identity Pride ~~ Empowerment and Efficacy
Stage 6: Identity Synthesis ~~ Congruence
Topics will depend on the format of the group

Recommended topics for psychoeducational groups:
Safe sexual practices
Legal rights of LGBTQ persons
Local resources

Recommended topics for counseling groups:
Identity development
Mental health concerns
Groups for LGBTQ clients often occur in one of two formats:

Format is determined by needs of the members, intended topics of discussion and goals, and therapist background

Psychoeducational groups may need to adopt characteristics of counseling groups during some sessions, and vice versa
Group leaders must make several decisions about membership including:
Sexual Identity
Relationship Status
Stage in the Coming-Out Process
Issues That May Surface
Tension among members, especially around the coming-out process
Older members with established identities may pressure newer members who are still closeted

Transference on the part of the clients

Countertransference on the part of the counselor(s)

Privacy concerns/breach of confidentiality

Acts of homophobia or harassment
Special Populations
Many LGBTQ-affirmative counseling groups are designed for specific populations

As always, counselors who choose to work with a specific population should research that population carefully
Transgender Clients
Transgender clients have unique needs

They may benefit from transgender-only group counseling

Counselors must be careful not to support or oppose the medical model
Instead, they should support the individual client's wishes

Provide clients with transgender-affirmative materials and educate them about local resources
New Directions and Things to Consider
Telephone counseling for end-stage AIDS patients

Different types of psychoeducational groups directed towards specific populations
Hip-hop groups about HIV prevention for African American adolescents
Telephone support groups

Resources for counselors:
University websites
Ball, S. (1994). A group model for gay and lesbian clients with chronic mental illness.
Social Work, 39
Chojnacki, J. T., & Gelberg, S. (1995). The facilitation of a Gay/Lesbian/Bisexual support-therapy group by
heterosexual counselors.
Journal of Counseling & Development
(3), 352-354.
Dickey, L.M., & Loewy, M.I. (2010). Group work with transgender clients.
The Journal for Specialists in Group
Work, 35
(3), 236-245.
Fetner, T., Elafros, A., Bortolin, S., & Drechsler, C. (2012). Safe spaces: Gay-straight alliances in high schools.

Canadian Review of Sociology, 49
(2), 188-207.
Firestein, B. A. (2008). New perspectives on group treatment with women of diverse sexual identities.
Journal for Specialists in Group Work, 24
(3), 306-315.
Holahan, W., & Gibson, S. A. (1994). Heterosexual therapists leading lesbian and gay therapy groups:
Therapeutic and political realities.
Journal of Counseling & Development, 72
(6), 591.
Horne, S. G., & Levitt, H.M. (2004). Psychoeducational and counseling groups with gay, lesbian, bisexual,
and transgendered clients. In J. L. Delucia-Waack, D. A. Gerrity, C. R. Kalodner, & M. T. Riva (Eds.),
Handbook of group counseling and psychotherapy
(pp. 224-238). Thousand Oaks: Sage Publications.
Lenihan, G. O. (1985). The therapeutic gay support group: A call for professional involvement.
Psychotherapy: Theory, Research, Practice, Training, 22
(4), 729-739.
Liddle, B. J. (1997). Gay and lesbian clients' selection of therapists and utilization of therapy. Psychotherapy:

Theory, Research, Practice, Training, 34
(1), 11-18.
Morrow, D. F. (1996). Coming-out issues for adult lesbians: A group intervention.
Social Work, 41
, 647-656.
Muller, L. E., & Hartman, J. (1998). Group counseling for sexual minority youth.
Professional School
1(3), 38.
Nel, J. A., Rich, E., & Joubert, K. D. (2007). Lifting the veil: Experiences of gay men in a therapy group. South
African Journal of Psychology, 37(2), 284-306.
Walters, K. L., & Simoni, J. M. (1993). Lesbian and gay male group identity attitudes and self-esteem:
Implications for counseling.
Journal of Counseling Psychology
, 40(1), 94-99.
Group leaders are advised to conduct pre-group interviews for several reasons:
Determine whether this individual is appropriate for the group
Refer individuals who are not appropriate to other groups
Determine needs of potential group members
Provide an introduction to group norms
Explain the requirement for confidentiality
Describe expectations for participation
Explain therapist qualifications and theoretical approach
HIV+/AIDS Clients
HIV/AIDS do not exclusively affect LGBTQ persons, but there is additional stigma attached to a diagnosis
LGBTQ youth are at a higher risk for depression, anxiety, suicide, substance abuse, harassment, and homelessness

Group counseling for LGBTQ youth often occurs through peer support groups and gay-straight alliances in schools

Forming outside support groups can be difficult due to state laws about parental consent and treatment of minors
Support groups are helpful for those with an HIV/AIDS diagnosis, as well as those who have lost partners or loved ones to the disease
Group counseling provides unique opportunities that individual counseling does not

LGBTQ individuals frequently experience low self-esteem and isolation--membership in a supportive group can counteract these negative feelings

Participation in a group can lead to increased contact with other LGBTQ individuals and resources
Prevention groups have four goals:
Development of self-identity and social support
Safe-sex education
Eroticization of safe sex
Negotiation of safe sex
Counselors should always promote activism, awareness, and safe sexual practices!
Kelly Jones
December 2013
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