Presented by Traci Hill LPC LGBTQ Persons Human Development and the Development of Coming Out Predominance per the Williams Institute UCLA School of Law 2011 There are more than 8 million adults in the US who are lesbian gay or ID: 595245
Download Presentation The PPT/PDF document "Competent and Ethical Counseling of" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Competent and Ethical Counseling of
Presented by:Traci Hill, LPC
LGBTQ
PersonsSlide2
Human Development and the Development of ‘Coming Out’…
Predominance (per the Williams Institute, UCLA School of Law – 2011)
There are more than 8 million adults in the US who are lesbian, gay or bisexual, comprising 3.5% of the adult population. Slide3
Human Development and the Development of ‘Coming Out’…
Predominance
In
total, their study suggests that approximately 9 million Americans – roughly the population of New Jersey – identify as LGBT
.
1.8% identify as
bisexual
1.7% identify as lesbian or gaySlide4
Human Development and the Development of ‘Coming Out’…
PredominanceEstimates
of those who report any lifetime same-sexual behavior and any same-sex sexual attraction are substantially higher than estimates of those who identify as LGB.There are nearly 700,000 transgender individuals in the US
19 million Americans (8.2%) report they have engaged in same-sex sexual behavior.
Nearly 25.6 million Americans (11%) acknowledge at least some same-sex sexual attraction.Slide5
Human Development and the Development of ‘Coming Out’…
The Stages of Coming Out
The Cass Model (1979):1. Identity Confusion2. Identity Comparison
3. Identity Tolerance
4. Identity Acceptance
5. Identity Pride
6. Identity
SynthesisSlide6
Human Development and the Development of ‘Coming Out’…
The Stages of Coming Out
The Cass Model (1979):1. Identity ConfusionSees self as member of mainstream group. Denial of inner feelings.
Who am I?
Am I different?Slide7
Human Development and the Development of ‘Coming Out’…
The Stages of Coming Out
The Cass Model (1979):2. Identity ComparisonBegin to come out of the "fog."
Maybe I am gay.
I'm alone.
What are gay people like?Slide8
Human Development and the Development of ‘Coming Out’…
The Stages of Coming Out
The Cass Model (1979):3. Identity ToleranceEncounter someone or something that breaks through the denial system.
I accept the possibility that I may be gay.
Where are other gay people?Slide9
Human Development and the Development of ‘Coming Out’…
The Stages of Coming Out
The Cass Model (1979):4. Identity AcceptanceExploring subculture activities, readings, etc.
I am gay.
Am I okay?
I can come out to some people.Slide10
Human Development and the Development of ‘Coming Out’…
The Stages of Coming Out
The Cass Model (1979):5. Identity Pride
Feel arrogance/pride in new identity and deep rage toward majority culture. May adopt/heighten stereotypical behaviors or characteristics (i.e. "I'm different and proud of it!"
.)
May isolate self from mainstream values and activities.
I am proud to be gay.
I don't (and won't) pass for straight.Slide11
Human Development and the Development of ‘Coming Out’…
The Stages of Coming Out
The Cass Model (1979):6. Identity Synthesis
Acceptance and integration of new identity. May go through five stages of grief to let go of old identity and all advantages of heterosexual privilege. Internalize pride/positive feelings about identity. Typically is "out" (with friends, family, at work). More at peace with self.
I am an okay person who happens to be gay.Slide12
PASSING
COVERING
IMPLICITLY
OUT
EXPLICITY
OUT
Lying
Censoring
Truth without LGBT labels
Affirming LGBT identity
I assume you
do not
know.
I assume you
do not
know.
I assume you know, but
I
a
m
not sure.
I know you know. You know I know you know.
See me as heterosexual
Do not
see me as LGBT
You can see me as LGBT if you want to
See me as LGBT
Human Development and the Development of ‘Coming Out’…
The Stages of Coming Out
Identity
Management
(Griffin, 1992)Slide13
Human Development and the Development of ‘Coming Out’…
Coping with Family/Social Reactions(Handbook of Counseling and Psychotherapy with LGBT Clients, 2nd
editon, Bieschke, Perez,
Debord
)
There
are two different aspects to coming out.
1. Acceptance
of one’s non-heterosexual identity
Coping with internalized homophobia
2. Disclosing ones identity to
others
An affirmative counselor can model a positive response that can facilitate the client’s movement toward self-acceptance. Conversely, a counselor who reinforces negative social messages can thwart this process or cause additional
distress.Slide14
Coping with Family/Social Reactions
Coming out is a life-long process… LGBT individuals have to do it over and over…FamilyWork
FriendsOthers…
Human Development and the Development of ‘Coming Out’…Slide15
Coping with Family/Social Reactions
Factors which mediate impact of family reaction:(Coming Out and Internalized Homophobia, C. House)
Strength of religious valuesFamily values regarding traditional gender roles
Family’s view of itself in relation to the community
Human Development and the Development of ‘Coming Out’…Slide16
Stages of
Adjustment For Families
1. Subliminal Awareness A non-heterosexual orientation may be suspected because of specific behaviors, same sex-friends, not dating heterosexually, dress and language use, changes in communication (not addressing certain subjects)
Human Development and the Development of ‘Coming Out’…Slide17
Stages of
Adjustment For Families
2. ImpactOccurs when the truth is made apparent
The
revelation crisis: the negotiation of new family roles
Experience
of loss of the member’s previous family role
Feelings
of guilt/failure (for “abnormality”)
Siblings may react with anger/confusion, experienced as stranger despite shared childhood
Human Development and the Development of ‘Coming Out’…Slide18
Stages of
Adjustment For Families
3. AdjustmentInvolves the family’s initial attempt to adapt to the non-heterosexual family member
Role
clarification and adjustment
Human Development and the Development of ‘Coming Out’…Slide19
Stages of
Adjustment For Families
4. ResolutionThe family discards the fantasized heterosexual identity for the non-heterosexual identity of the family member
Family
members begin to examine their own values about non-heterosexuality and modify them in light of new and often intimate knowledge of non-heterosexual persons
Human Development and the Development of ‘Coming Out’…Slide20
Stages of
Adjustment For Families
5. IntegrationFamily adjusts values in order to incorporate the non-heterosexual identity into the family
Family members learn to de-emphasize the small part of the non-heterosexual family member’s identity that is different
and retain the majority of the person’s known and loved attributes
Human Development and the Development of ‘Coming Out’…Slide21
Gay Adolescence
Identity Pride (Stage 5 of The Cass
Model)Recommended for review: ‘Does Your Gay Age Match Your Chronological Age?’ at www.joekort.com
Typical
behaviors and impacts… and
issues seen
in counseling at this
stage?
Human Development and the Development of ‘Coming Out’…Slide22
Developing Healthy Social Support and a Chosen
FamilyIdentity Acceptance (Stage 4 of The Cass Model)Ex’s, Mentors, and other Accepting
IndividualsProvide a lifetime of emotional support from people who understand them in a way that straight family never will.
“Family
of C
hoice”, “Gay
F
amily”
(this
may include ex-partners)Human Development and the Development of ‘Coming Out’…Slide23
Compounding Issues / Impact Themes
Organic/Genetic: mood disorders, anxiety, etc.
Family or Origin Issues/Trauma
LGBTQ? Can I accept myself? Will others accept me?Slide24
Compounding Issues / Impact Themes
LGBTQ? Can I accept myself? Will others accept me?
Mental
Health
Recommended for review:
‘New Data on Lesbian, Gay and Bisexual Mental Health’,
DeAngelis
, APA, Vol. 33, No.2
‘Prevalence of Mental Disorders, Psychological Distress, and Mental Health Services Use Among Lesbian, Gay, and Bisexual Adults in the United States’, Cochran, Sullivan, and Mays, Journal of Counseling and Clinical Psychology, 2003, Vol. 71, No. 1
And regarding the possible development of Axis II symptoms… ‘Personality Disorders in Gay, Lesbian, Bisexual and Transgender Chemically Dependent Patients’ by Grant, Flynn,
Odlaug
, and SchreiberSlide25
Compounding Issues / Impact Themes
LGBTQ? Can I accept myself? Will others accept me?
Substance Use/Abuse
Recommended for review: Healthy People 2010, Substance Abuse Report (CDC)Slide26
Compounding Issues / Impact Themes
LGBTQ? Can I accept myself? Will others accept me?
Overcompensation / Overachievers
– self
-esteem and worthiness issues
“
The Gay Tax
”
Recommended
for review: “Another Consequence of Homophobia: Overcompensation”, by Dr. Anthony Grollman
, 2013.
“The
Best Little Boy in The
World,”
by Andrew
TobiasSlide27
Cultural Concerns
The LGBTQ Community / “Gay Culture”
The flag and other symbolsTerms / language / code
Subcultures
Small communities
“
Gayborhoods
”
Gathering places
“
Gaydar
”
OKC / Oklahoma LGBTQ Culture
BoundariesSlide28
Cultural Concerns
Spiritual ConsiderationsIn Oklahoma
Books that may be helpful:The Lord is my Shepherd and He Knows I’m Gay by Troy Plummer
Stranger at the Gate by Mel White
Christianity, Social Tolerance and Homosexuality by John Boswell
The Alchemist by Paula Coelho
We Were Baptized Too by M. Alexander and J. Preston
Also helpful to family members:
“Letter to Louise” by Bruce LoweSlide29
Cultural Concerns
LGBTQ AND: Native American… the “two-spirit people”…
2-Spirit Organizations: Native Out – www.nativeout.org, Central Oklahoma Two Spirits Society
Asian… “…a failure of the parents and a rejection of
family and culture”
(
Bieschke
, Perez,
Debord
)The Gaysian, The Gay Asian’s Lifestyle Guide – includes a list of resources and organizations supportive to gay Asian-Americans
Latino… possibly ok if in “the active or
insertive
role…”
(
Bieschke
, Perez,
Debord
)
Llego
’, The National Latino/a LGBT Organization: 202-544-0092
African American… “The Down Low / DL”
The National Black Justice Coalition, see website or call: 202-319-1552Slide30
Cultural Concerns
LGBTQ AND: Aging… risk of social exclusion / importance of community…
“I do not want to be looked after by someone who dislikes me because I am a lesbian.” Sheila, age 57
For more info see: Working with Older Lesbian, Gay and Bisexual People, a Guide for Care and Support Services” by the Stonewall organization
SAGE (Services and Advocacy for LGBT Elders) – Tulsa Chapter –
SAGE@Okeq.org
Outt
Late – a support group for lesbians that came out later in life – Cimarron Alliance, OKCSlide31
Cultural Concerns
LGBTQ AND:
Youth… the rate of suicide attempts among GLB youth are 20 – 40% higher than among non-GLB youth – per NAMI.
Trevor Suicide Prevention Line 1-800-850-8078
Rainbow Youth Hotline 1-877-542-8984
GLBTQ Youth Advocacy
www.youthresource.com
Locally: YES (Youth Equality Services)
LGBTQ Support Group every
Tue
evening at
Expressions, in Common Grounds Coffee Shop at 2245 NW 39th
Kris Williams, Coordinator 405
-600-1052Slide32
Cultural Concerns
LGBTQ AND: For Oklahoma Specific LGBTQ Community and Support Information:
The Cimarron Alliance Equality Center – 405-495-9300 At 56th and N. May, www.equalityokc.org
Oklahomans for Equality, Tulsa – Helpline: 918-743-4297 or
www.okeq.orgSlide33
The “T” (Transgendered)
OverviewDevelopment / General Information
“I knew something was different at age 4,5,6…”The Transexual Person in Your Life at www.tsfaq.info
www.Susans.orgSlide34
The “T” (Transgendered)
OverviewThe Tg “Umbrella”
Cross-dressingTransvestite
Gender Queer
TransexualSlide35
The “T” (Transgendered)
DiagnosisGender Identity Disorder, now Gender
Dysphoria
…the criteria…
Complications:
Depression or anxiety
Poor self concept
Body image issues / obsession
Emotional distress
Feeling alone
SuicideSlide36
The “T” (Transgendered)
Role of the TherapistStandards of Care
Dr. Harry Benjamin / The Benjamin Standards of Care … …1948, 1966, and today…World Professional Association for Transgender Health (WPATH)Slide37
The “T” (Transgendered)
Role of the TherapistFamily-Centered Treatment
Assisting parents, spouses/partners, children in the adjustment process…Coping in the Community
When, how, and to whom to “come out”
…
Advocacy
Education / Consultation
The “Bathroom Letter”Slide38
The “T” (Transgendered)
Role of the TherapistYouth and Children
Timing / case-by-caseParents and split families
Support
Involving the
doctor
When to Refer / Consult
“We shouldn’t have to educate our therapists.”
-
- a client in transition
Thorough evaluation
Comorbid issuesSlide39
The “T” (Transgendered)
The TransitionSocial / Emotional
SelfFamily
Work
Community
Physical
Hormones, hair and hips
…
Medical
Hormones
Surgical Options
Local
resources
Every transition is different – a “completed transition” for one may be very different than that of a another…Slide40
The “T” (Transgendered)
Developing a Healthy Support NetworkOnline support/community
Local support groups / communityCimarron Alliance – Saturdays at
5pm
Local LGBTQ-friendly churchesSlide41
Clinical Considerations
Personal BiasHeterosexism: (Handbook of Counseling and Psychotherapy with LGBT Clients, 2nd edition)
Defined as: “The ideological system that denies, denigrates, and stigmatizes any nonheterosexual form of behavior, identity, relationship or community.
”
“…refers to the premise that all people are heterosexual unless and until they indicate otherwise…therapists frequently operate under this premise…
”Slide42
Clinical Considerations
Personal BiasHeterosexism:“The
client’s current identity may not be a fixed point, but rather fluid… it is important not to make assumptions based on current behavior or marital status”Communicating openness to clients:
Promotional
materials / nondiscrimination
statement
Forms
OfficeSlide43
Clinical Considerations
Overcoming Heterosexism:
“A critical first step that counselors need to take to avoid perpetuating heterosexism is to perform an honest self examination of their own attitudes and beliefs regarding sexual orientation,”“Mental health professionals live in the same heterosexist society as everybody else and are subject to biases and prejudices that permeate that culture.”Slide44
Clinical Considerations
Areas to explore:
To what degree do you consider a range of possibilities as viable?Do you perceive a variety of equally acceptable alternatives with respect to sexual orientation, or is heterosexuality considered preferable, with other identities being acceptable but less preferable (or even unacceptable)?
To
what extent do you place limits on those who do not identify themselves as heterosexual (career, parenting,
etc
)?Slide45
Clinical Considerations
Areas to explore:
To what degree do you fully embrace the professional organizations’ removal of homosexuality as mental illness?Do you view LGBT orientation as indicative of instability, regardless of the official position of your association?
What are your religious beliefs regarding the ‘shamefulness’ or ‘sinfulness’ of
nonheterosexual
orientations?Slide46
Clinical Considerations
Areas to explore:Religion can be a particularly difficult problem for LGBT individuals, often bringing them into therapy.
“Therapists need to be able to help clients address religion and spirituality in ways that are affirmative, not further condemning.”Conversion TherapySlide47
Clinical Considerations
APA Practice Guidelines for LBGUnderstand the effects of stigma
Understand these orientations are not mental illnessesUnderstand that same sex attractions feelings and behavior are normal variants of human sexualitySlide48
Clinical Considerations
Boundaries Can we install and maintain the same boundaries with LGBTQ clients as we would with heterosexual clients? Or is there an ‘extra wall’
?Slide49
Clinical Considerations
ConfidentialityDo we maintain the same level of confidentiality for
nonheterosexual clients, or are some things just too juicy not to share (even without names)?Small communities…Slide50
Clinical Considerations
Informed ConsentBeing open and ready to inform clients of how much experience we have with their particular population /
issueSlide51
Clinical Considerations
Transference and Counter-TransferenceIf symptoms of transference are recognized, can we address them in the same way we would with heterosexual clients? Is there an increased level of fear / reactivity / revulsion?Slide52
Clinical Considerations
Transference and Counter-TransferenceRecommended for review: Countertransference Issues in Psychotherapy with Lesbian and Gay Clients, by Milton, Coyle, and Legg of the University of Surrey, UK 2005, in the European Journal of Psychotherapy Counseling and Health, 7, 181-197. Slide53Slide54Slide55
Clinical Considerations
Couples
Impact of social stigma on the relationshipMany variations
…
2 men
2 women
Ts
hetero
Ts
gayPolyamorousOthers?Slide56
Clinical Considerations
CouplesSome relationship issues are the same, no matter what ‘type’ of couple; i.e. fidelity, abuse, finances,
AoD, child-rearing, etc.Issues common to LGBTQ couples:
1 out, 1 not
Lack of family support
Increased incidence of
AoD
abuse/dependence?
Others?Slide57
Clinical Considerations
Advocacy and Assisting in Coping with DiscriminationBeing and providing a safe place for the individual to present as / BE their true self…
Provide education to decrease stigma and increase safety…within families, schools, communities,…Providing helpful documentation if
needed
Being willing to contact, screen, and meet with other professionals and community members as needed and as ROI’s allow…e.g. school counselors, doctors, clergy,
employers…Slide58
Clinical Considerations
Advice to Clinicians from LGBTQ Clients…“Be understanding, open-minded and supportive of it. Don’t
fight it.” 23 yr old
MtF
“Gender is a spectrum. It’s not rigid.
”
25
yr
old
MtF“…the profoundness of the feeling of isolation; of being alone… The most powerful, devastating beautiful thing is for someone to realize they’re not alone and never have been…to internalize this as heart’s knowledge --- if they can do that, they can do anything.
”
40
yr
old
MtFSlide59
Clinical Considerations
“The reason I came back after the first time is because I heard: ‘there is no judgement here.’”
44 yr old lesbian
“We have the same relationship as straight people…we don’t lay in bed all day being perverted. We get up, go to work and feed our kids. Other than having a same-sex partner, our lives are pretty boring.
”
45
yr
old
lesbian
“Do research so you know what you’re talking about….to know things like: trans people are not gay people. There are bad therapists out there that try to convince trans people that they’re really just gay. Have some resource knowledge, like doctors and support groups.
”
23
yr
old
FtMSlide60
Clinical Considerations
“Don’t tell someone that they aren’t what they think they are. Don’t let them know if you don’t believe it. Be careful with the use of pronouns. Be gentle because who knows what they’re missing out on in their life because of who they are -- sometimes they need someone to fill a role. Society’s recipe doesn’t work for everyone and sooner or later it won’t work for anyone.”
24 yr old polyamorous
,
FtMQSlide61
Things NOT to Say to LGBT
People“
Wow. I never would have guessed that you’re [gay, lesbian, bi, or transgender]!“Is one of you the husband and one the wife? I don’t get it.”
To
a transgender person: “What’s your real name? What did you used to look like?”
“
Your lifestyle is your business. We don’t need to talk about it here.”
“
It’s too bad you’re gay.”
“I have a friend who’s [gay, lesbian, bisexual, transgender] that you should meet.”Slide62
Things NOT to Say to LGBT
PeopleYou’re gay? That’s great. I love gay people.
Do you watch Glee?What should I [wear, do with my hair]?
Do you know if [insert name] is gay too?
Does that mean you don’t want kids?
Wait, you’re not attracted to me … right?