 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation on culturally responsive services with persons who are LGBTQ2IK. And we're not going to cover everything. And, you know, I'm going to put out there at the beginning the caveat that a lot of the literature that has been written is still only written or was written for LGBT. So the other sexual orientations that have been added to that aren't included and aren't spoken of as much. So I've done my best to kind of generalize and get you as much information as I could find that could be useful. And as always with culturally responsive services, you can't assume that anybody you meet is going to fit into this nice little package. You don't know how acculturated they are to the mainstream culture, how bicultural they are, et cetera. So we want to make sure to definitely check in with people before we assume that anything that we're going to talk about today really applies to them. So we're going to start out by learning terminology specific to the LGBTQ2IK community. Explore specific verbal and nonverbal communication issues. And let me say the beginning part of the terminology. I'm going to go through really quickly because you can review it on your own if you need a refresher on some of that terminology, but I want to get down to some of the nitty-gritty stuff. We're going to learn about the stages of the coming out process and review the Nissan's three-phase model for recovery from shame. And we're also going to talk about the cultural or the counselor's tasks at each particular phase. We'll talk about some LGBTQ2IK cultural issues and how race, culture, and ethnicity impact identity and development and acculturation. We'll identify specific treatment issues which may be unique to this population. And finally, we're going to learn about the Family Acceptance Project, which is an advocacy project that has been started to help families that are dealing with a child who is coming out and helping them figure out how to support that child. So terms, sex is basically just the genetic anatomical characteristics that people are born with. Intersex represents the fact that some individuals are born with a reproductive and sexual anatomy that doesn't fit typical definitions of male or female. Not all of these people identify as intersex. Sexual orientation is the person's emotional, sexual, and or relational attraction to others, including heterosexual, gay, lesbian, bisexual, asexual, intersex. Gender identity is our internal sense of being male or female. Because gender identity is internal, it's not necessarily visible to others. So sex is the external stuff, kind of what we're born with. Gender identity is more of a psychological concept, and so it's not necessarily visible. Transgender describes people whose gender identity expression is different from that typically associated with their assigned sex at birth. Gender identity in many cases is independent of sexual orientation. So you don't want to assume anything. A transgender person transitions to express gender identity through various changes, including wearing clothes and adopting a physical appearance that aligns with their internal sense of gender. So this is a gradual process. They don't just wake up one morning and suddenly change how they're acting or interacting most. I mean, some people finally reach that pivotal point and they're like, you know what? I'm going to be true to myself. But for other people is a gradual process. Gender expression is the manner in which people represent their gender to others through mannerisms, clothes, and personal interests. Now, the two in LGBTQI2K represents two-spirit, an inclusive term created specifically by and for Native American communities. It refers to an American Indian or Alaskan Native American people who express their gender sexual orientation and or gender sexuals in indigenous non-Western ways using tribal terms and concepts and or define themselves as LGBTQI in a Native context. So two-spirit, if you're working with somebody who is Native American or Alaskan Native might be a term that comes up. Heterosexism resembles racism or sexism and denies, ignores, denigrates, or stigmatizes non-heterosexual forms of emotional and affectional expression, sexual behavior, or community. Homophobia is defined as the irrational fear or aversion to or discrimination against LGBT behaviors or persons. Now, internalized homophobia is something we're going to talk about a little later and it describes the self-loathing or resistance to accepting LGBT sexual orientation. And it's an important concept in understanding LGBT clients because we're working with people who are in a society that sometimes says, you know what, you really shouldn't be here or you shouldn't be this way. So figuring out what they think. And so sometimes they internalize those negative messages and develop internalized homophobia and self-loathing. Lesbians are people who identify as female and are attracted to others who identify as female. Gay means anyone who's attracted to people of the same sex. So gay can be male or female. Bisexuals are attracted to both males and females. Transgenders are born a certain sex but identifies a different gender. Queer is actually a very inclusive term for anyone in the LGBT plus community. Choosing to identify as queer can mean individuals don't have to belong to a more specific category if they're not sure yet of their sexuality or gender or just simply don't want that label. Intersex means they're born a certain gender but their sexual or reproductive anatomy is from the opposite sex. Asexual and that's actually not even recognized in the acronym right now. When a person is asexual it simply means they aren't very sexually attracted to either sex and generally have a low level of interest and desire to take part in sexual activities. It doesn't mean that it's a pathology and that's one thing that they get a lot of times when they go into counseling and they start talking about relationships or whatever is they feel different because they don't have the sexual urges that some of their their peers do pansexual when someone is pansexual it means they're attracted to people regardless of their gender. They're attracted to people rather than one particular gender or sexuality. Polygamous or polyamorous are people who identify as having consenting open relationships with more than one person at a time and kink is about people who have kinky fantasies and this could involve BDSM which stands for bondage discipline dominance and submission and sadomasochism and some of the things that you may run into clients who have the kink affiliation female lead relationships Dom sub relationships straight up BDSM. So being aware of what's out there and what's within the range of normal and you know none of us really like that term normal because who are we to say what is okay. But being open to those sorts of concepts so moving on to the nitty gritty LGBT individuals have a creative vocabulary on the subject of sexual orientation and they may often use code words for safety reasons and you know you can kind of think about this they may say are you part of the community when you work with people with substance abuse issues especially alcoholism for example. And they meet somebody else they may say are you a friend of Bill and that means are you an alcoholics anonymous so it's a code word so you don't have to out yourself to everybody to find out if it's safe to talk about particular topics or whatever some LGBT individuals disapprove of words used to describe them so please ask there's a variety of terms and not everybody's comfortable with every term out there so just ask it's not offensive it's actually shows that you're interested in your trying to be empathetic and supportive. The term homosexual for example over emphasizes sexuality and seems to indicate that the sex act is more important to homosexuals than it is to heterosexuals it also resurrects memories of when homosexuality was considered a psychiatric disorder hence the words homo by queer or gay are preferred by some LGBT persons. On the same line some LGBT persons are offended by the term queer so ask transgender persons may prefer the less term less clinical term trans for obvious reasons you can see where transgender seems more clinical. It is important however when you're talking to a transgender person and this is generally a lot closer to universal to call the person by his or her preferred name go figure and always use the gender designation that is chosen by the client so if the client is identifying as male you want to use the male pronouns LGBT individuals rely tremendously on nonverbal cues to establish whether the situation is safe for them to be themselves so we want to make our offices and our environments. Full of evidence that they're safe and they can be accepted and welcomed in our in our clinics a rainbow colored flag is a good thing to have around and you can have a little rainbow colored flag in the pencil holder of your desk you don't have to you know go to great. What's the word I'm looking for interior design steps small things let people know it's safe a straight but not narrow bumper sticker on a car and in the parking lot. That can be a hint a mission statement that includes a commitment to honoring diversity or a commitment to treating LGBT clients have it out there have it written out there that you're you have a commitment to providing a safe welcoming and nurturing environment. If you have the presence of gay or lesbian staff members most areas. The community is relatively small now that's not true everywhere some places the community is huge but a lot of times people who are gay lesbian transgender are going to the same social places going to the same bars going to the same restaurants and stuff so they may get to know each other and they see somebody they know they may feel a little bit more comfortable it's not like you can just identify somebody who's gay or lesbian but if somebody's there and they know each other. Materials used in treatment need to acknowledge the LGBT experience so we want to figure out more providing case scenarios when we're providing examples when we have when we're choosing literature and stuff to be out in the lobby we want to make sure that the LGBT person is represented we want to make sure that their concerns are represented in contrast to how members of ethnic cultures are marginalized LGBT individuals may receive disapproval and censure from those whom they most trust and rely on their parents relatives religious leaders teachers and friends to think about that you know that was one that kind of stuck with me for a while because it hadn't occurred to me that I mean the fact that sometimes coming out results in a lot of family disruption and chaos I knew that. But I hadn't really thought about the fact that you know for other ethnic minorities they can go back to their culture of origin they can go back to their family they can there's a place they can go where they can feel safe but for a lot of LGBT individuals the place that they're supposed to feel safe is no longer safe. Most members of ethnic minorities can escape discrimination by returning to a supportive family or neighborhood. Additionally when they're growing up positive role models are not as easy to identify now with a lot of these new television shows there are a lot more role models there are a lot more people that are openly gay transgender that can serve as role models for people so that's good I mean we're making progress we're not there yet but we are making progress. The LGBT culture is also one that is not developed taught or transmitted by families so if somebody you know figures out that they're of a minority sexual orientation then they've got to figure out what do I do with this you know generally you're raised in a family where girls are expected to marry off and become wives and men are expected to marry off and become husbands and this is how it goes and yada yada well that's not the case here and so figuring out exactly what they're supposed to do and where they're supposed to go and becomes a question and we're going to talk even more about that later when we talk about the fact that there's not even a consensus on the correct way if you will to be gay the correct way to embody this culture or exactly what this culture is so it's still sort of influx a little bit part of gay culture for some people is the celebration of being gay not everybody chooses to come out of the closet not everybody chooses to embrace their sexual orientation that doesn't necessarily mean that they are I mean obviously they are still gay so we want to recognize that everybody's level of comfort with celebration of being gay is going to be very different because public acceptance is important many LGBT persons want to advance the message that LGBT individuals are no different from non LGBT persons you know they have marriages they have children they're successful in business they you know it's a very fulfilling life but there's another camp of persons that are worried that highlighting the similarities and positive aspects of gay culture could mean the loss of the culture as the LGBT community and just being kind of sucked into mainstream culture and they have a lot of pride you know this second camp really likes their individuation as a unique culture and then some believe that the gay community should try to transform mainstream society rather than to join it so there are different ways about how do we advocate how do we handle the LGBT culture in terms of integrating or interacting with other cultures the other aspect of the debate involves differences about whether there's only one way to be gay which may lead to not honoring LGBT persons with other lifestyles or opposing views bisexuals for example experience that oftentimes lesbians and gay men do not accept bisexuality as a legitimate sexual orientation but regarded as a developmental phase on the way to acceptance of a lesbian or gay identity again this is changing some to but it's important to recognize that there are still you know just like in any culture there are still some people that are much more traditional and there are more people that are more progressive cultural factors don't impede sexual identity formation sexual identity formation is a developmental process we all go through cultural factors do delay or negatively impact identity integration involving internal and external acceptance and comfort of being with being known as LGBT so it's important to understand that the sexual identity is going to form now the race culture and ethnicity can impact whether the person's okay with that or they internalize the homophobia and develop a strong self-hatred and have negative mental health outcomes. There's positive engagement in LGBT social activities if the culture is not okay with that then people are not going to reach out and engage in positive activities and develop a link with that community which as we just said LGBT culture is not transmitted through family so the only way to develop their identity as an LGBT person and figure out what it means is to be involved with the culture so if they're not out there doing it they're going to have they're going to be struggling a little bit they know who they are they know what their preferences are but trying to figure out how to fit into that community is going to be more of a challenge. Cultural factors affect internalized anxiety and avoidance as they relate to the LGBT QI to S's individual experience with attachment figures. For example secure attachment during the coming out process enhances coping with anti-gay prejudice self-acceptance and self-esteem which makes sense if the person believes they can go and tell mom or dad that guess what you know I'm gay I'm lesbian I'm transgender and they feel like they can do that without losing parental love and it goes as well as can be expected then there's a much better outcome and the person will not internalize as much self-loathing if they're like okay mom and dad can handle that that's cool. In addition to understanding a client's ethnic background counselor should keep in mind how the client's culture views LGBT individuals and the effect this viewpoint has on the client. Each ethnic minority group has norms and values about LGBT members and behavior. For example LGBT persons of color may cope with trying to fit into the gay and lesbian communities in the face of racism and discrimination. So not only do they face racism and discrimination in the community at large but they also face racism and discrimination within the LGBT communities. For some the added burden of these issues makes finding a comfortable place in society even more complex and difficult. In certain collectivistic cultures cohesiveness of the group is an important value and because of this shame is a frequently used social constraint to control or deter expressions of homosexual behavior. So think back to the culturally responsive webinars we already did when we're talking about persons persons who are Asian persons who are Hispanic persons who are African American. There's a large portion of people out there who have come from a collectivistic culture that is you know that could influence how much or how well or how easily they embrace their sexual identity homophobia in the African American community is often more intense than in the dominant community. So it's important to recognize many LGBT African Americans say that they do not feel welcome or comfortable in predominantly Caucasian LGBT settings. So they face discrimination in Caucasian settings but there's a lot of homophobia in the African American community. So you know persons of color may find that they don't feel like they fit in in Hispanic culture some men who have sex with men do not consider themselves gay if they play the dominant role in the sexual act. So this is important to remember when working with Hispanic clients because Hispanic culture being very collectivistic and there's a lot of issue with machismo and males being the center of the family. There's a lot of difficulty for men in the Hispanic culture to acknowledge that they may be gay bisexual or transgender. So what do we do let's enhance assets early and continuous attachment positively shapes relationship development in later years among all children adolescents and adults and internal locus of control is going to facilitate self-efficacy. So if we can help children grow along the way if we can help parents learn how to provide unconditional positive regard then you're going to be able to ensure that they're going to have a better outcome or hopefully have a better outcome protective factors in one setting can compensate for the risks in multiple settings. So if they have a stable home base if they've got a nurturing home base for example that's going to go a long way even if at work and at school and you know with some of their friends the coming out process doesn't go as well if they have a nurturing home base where there's protective factors they are going to be better off studies of resilience for youth who are sexual gender minorities have demonstrated positive social relationships moderate the relationship between stress and distress so no different than the community at large. Affirming faith experiences contribute to less internalized homonegativity more spirituality and psychological health and a lot of people think that the church is against gay people the church is against LGBT QI to K but in reality and these links will take you to it there are a lot of churches that are recognizing the reality of the fact that there are a lot of people out there who are LGBT who are among the sexual minority. The Episcopal Church for example has approved the ordination of transgender people in 2010 150 orthodox rabbis and educators signed a declaration calling for the welcoming of LGBTQ Jews in the orthodox community and those are just two of the headlines but this current perspectives on religion if you click on that it lists a bunch of the religions I'm sure they don't have all of them out there and you can read their basic position on LGBTQ family support and acceptance explains adolescent comfort and resilience in later life so it's so important for the person who identifies as a gender or sexual minority to feel that they have got family support and acceptance. The term coming out refers to the experiences of lesbians and gay men as they work through and accept a stigmatized identity transforming a negative self identity into a positive one. Now there's no correct process or single way to come out and some LGBT persons don't ever come out so when you're working with somebody who identifies as LGBT to I.K. We want to make sure that we recognize how much they're willing and comfortable coming out or how much they're planning on coming out. But regardless we want them to transform their identity into a positive one even if they don't come out you know how can you feel the way you feel and be who you are if you're not going to come out. How can I help you be happy and healthy and all those sorts of things. SOMSA providers introduction to treatment for LGBT individuals provides a lot more information on this topic. We're going to hit the highlights real quick. The CAS model stage one the person experiences identity confusion and it occurs when a person begins to realize that he or she may relate to or identify as being LGBT. This is a process of kind of personalizing identity. So during this time we want to help people explore what does this mean to them and increase awareness of you know what their feelings are what their attitudes are what the communities attitudes are so they know what's going on and they can be they can start exploring what this identity means to them. They may have feelings of anxiety and confusion and that's okay. We want to help them get past that confusion and deal with figure out what their anxiety is about and start dealing with that. Some of the defenses in this stage may be denial. They may say you know what no that's just it was just a phase it's I'm not really lesbian or gay or whatever the case may be. So during this period it's really important for somebody to have a confidential support person that they can lean on when they're trying to figure out what's going on and they have those anxieties coming up somebody that they can talk to. During stage two is identity comparison. The person accepts the possibility that he or she might be LGBT. So during this time we want to explore the implications and encourage people to encounter others like themselves. Now they may not be ready to do that and that's okay. They're going to take the lead in this. There can be feelings of anxiety at this point still but there also can be feelings of excitement like okay I might be able to do this. If somebody's having difficulty in this stage and there are times that they may they may start bargaining or rationalizing and going you know if it turns out you know please just let this be a phase you know if this happens then I'll do whatever or they could rationalize like I said they may rationalize and think it's a phase during the recovery stage of this phase. We want to help people start meeting other similar gay lesbian bisexual transgender persons if they're comfortable with that if not one of the things that you might do is encourage them to find role models online or on in the media so they can start exploring what it means to be LGBT. Stage three is identity tolerance and occurs when a person comes to accept the probability that he or she is an LGBT person. They want to or they need to start recognizing their social and emotional needs as an LGBT person what does that mean what do I need from my family from my community for myself. They may have some feelings of anger at this point I didn't want to be this way I didn't want this to happen but they also again may still have feelings of excitement. During this phase we can help people try to figure out what it means to them to be gay. How do you do that and enjoy a rich and meaningful life how how can I be gay and be my utmost person you know how how do all these things fit together and helping them see how that contributes to their life and their happiness. Identity acceptance occurs when a person fully accepts rather than tolerates himself or herself as an LGBT person. So we want the person to start developing community and integrating with others now they may not be out to all of their peers yet and may never be but at least they have a community and they are starting to associate with other LGBT persons. They may have some feelings of rage and sadness it's not fair that I have to be two different people or it's not fair that you know I'm this way whatever the case may be they may have hostility towards straight culture for the way that they feel like they're treated so it's important to figure out what may be prompting that hostility where do they feel oppression where do they feel that they're being denigrated where they do they feel lack of acceptance from and those can all become therapeutic issues. They want to continue at this point we want to encourage them to continue community building. Stage five is identity pride and the person at this point immerses himself or herself in the LGBT community and culture to live out their identity as totally as they can for them. During this point we want them to have the full experience of being an LGBT person and confront internalized homophobia not everybody comes to this stage not everybody is wanting or willing to be out there and fully experience what this means. And that's a choice that's a very acceptable choice if they don't want to come completely out. If you working with somebody that you know chooses to embrace the lifestyle they may have feelings of excitement and some focused anger at people institutions here and there at this point there's an arrogant pride and rejection of straight culture as the norm you know they are proud. We want to help people integrate their sexuality identity and recovery so if they came to us because they were dealing with anxiety and depression and self-esteem issues and everything we want to help them integrate everything into this one beautiful well package and finally identity synthesis occurs when a person develops a fully internalized and integrated LGBT identity and experiences himself or herself as whole when interacting with everyone across all environments. So during this period the person continues coming out as fully as possible they may begin intimate gay or lesbian relationships. And self-actualization begins who am I really how can I be my best self so we started that in the last phase and we're really working towards it now gangbusters. The person is excited and happy they're not defensive they are this is who I am and I love myself and this is awesome. So for us at this point we're terminating you know the person is happy they don't need to be in counseling anymore we want to encourage them to be happy and you know if they come upon discrimination or oppression or whatever it is they have the tools to deal with that but at that point if it becomes problematic they can come back to counseling but you know they've moved through the process and they are rocking and rolling. Unfortunately as this process goes there's a parallel process and it's a recovery from shame because our straight community the majority community still tends to stigmatize and oppress those of sexual minorities. So the first phase in the nieces three phase model is breaking the silence it's important for the LGBT individual to tell their story and address the pain of being different in a heterosexist society so encouraging them to look at what is it what is heterosexist mean to them and what does it mean to be different we can facilitate their discussion of hiding their LGBT feelings from others we can explore the emotional costs of hiding or denying their sexuality does that mean we're encouraging them to not do it not necessarily we want to let the client take the lead about what they think is safe because there's costs and benefits to everything decisional balance exercises are great here to discuss how the client has tried to fit in and at what cost because there's a lot of stress associated with trying to pass as heterosexual so we want to talk about that examine negative feelings of self-blame feeling bad or sick and the effect of shaming messages on the client and again I am so thrilled to see so much more openness in the media at least to people who are sexually different is awesome and fostering a client's ability to be out so during this first phase we're wanting to help them figure out what does it mean to be out and what do I need in order to come out phase 2 allows clients to understand their struggle in the context of societal discrimination and prejudice so as clinicians we can facilitate focusing and managing anger constructively not destructively remember in the coming out process there was there were several stages where anger was a predominant emotion so how could you use this anger remember anger represents a feeling of threat you feel threatened you feel oppressed for some reason where's that coming from and how can you use that energy just being angry isn't going to fix anything so how can you use that energy to improve the next moment to improve society to improve your environment we want to help the client understand and accept negative self-image as sociocultural and not personal so we're starting to address that internalized homophobia and counteract clients experience of heterosexism and homophobia by role modeling and providing a treatment environment that's empowering for LGBT persons not stigmatizing look around at what messages you have out there and whether it's accepting and and productive or destructive phase 3 is when they reclaim personal power it involves improving self-concept self-esteem and self-concept you remember the last phase of the coming out process with self-actualization so we're kind of paralleling still we can help the client facilitate their own self-efficacy and self-concept you know who are you you know let's define who you really are when you you've stopped you know trying to fit in and trying to be what you think everybody wants you to be who are you identify and change negative messages to affirmations you know if they get a message that it's not okay to love somebody of the same gender how do you change that to an affirmation I deserve love and I deserve to love recognize and release residual shame develop a positive affirming spirituality and remember spirituality is that connectedness that sense of being part of something and interconnected to the world is not necessarily religion integrate well before I move on it is important for a lot of people not everybody at this point to find a church home find a home within their religion that is accepting of them if they were raised you know Buddhist or if they were raised Christian or or Jewish or whatever it is very helpful to encourage them to find a welcoming environment not all churches you know even if the person goes to an Episcopalian church for example not all Episcopalian churches are going to be welcoming as others so testing out different churches in different communities to figure out where there's a good home can be helpful if spirituality and especially religion is important in their lives encourage them to integrate their public and private identities so they're not you know trying to live two lives because that's exhausting and build a support network connecting to the LGBT community but also to persons in the straight community who are supportive other treatment issues one third of suicide first attempts of LGBT youth occurred within the same year of self-identification as gay or bisexual so if you work with adolescents this is an important factor one third of suicide first attempts occur within a year of self-identification so there's a lot of chaos and conflict going on within that person's mind counselors need an understanding of the dynamics of LGBT interpersonal relationships including the internal and external problems of same-sex couples so you know same-sex marriage is allowed in certain states not allowed in other states recognized by some providers not recognized by other providers when we're thinking insurance and other things so there are a lot of unique stressors within relationships that are unique to the LGBT relationships and we want to make sure that we understand the broad diversity and variety of relationships in the community on top of that although many individuals have a life partner others are single or in nontraditional relationships outside the cultural norm of the heterosexual monogamous legally sanctioned marriage so and this is another thing that I've seen growing over the years over the past decade the people that are in non monogamous relationships or non legally sanctioned marriages has gone up quite a bit so being aware of the different options out there and exploring any of your personal biases as it relates to you know whether marriage is supposed to be through a man and a woman monogamous and all those things what does that mean to you as a clinician many LGBT individuals are parents and have children from heterosexual marriages adopted children or children through other means such as in vitro fertilization parenting issues and helping children deal with oppression because they're being raised by gay parents may also be very salient issues for these parents growing up in a society that says they should not exist LGBT clients may have internalized homophobia we can help them start looking at what kind of negative messages do you tell yourself if their parents and their raising children what kind of messages do you tell yourself about your children sexuality you know maybe because of your internalized homophobia you're saying you know they can't grow up to be gay or bisexual or whatever it is and that may or may not be true but we want to make sure that people are kind of looking at that and how society's messages impact them and impact everything they do LGBT people may be victims of anti-gay violence and hate crimes so trauma counseling may be appropriate LGBT persons experience stressors not only related to coming out but also is passing as heterosexual so if they haven't come out fully to everybody you know they may at their work environment for example feel they need to pass where in their private life they can embrace their not heterosexual identity HIV and AIDS continues to be a major factor in gay male life and it's also a factor in transgender life to a certain extent because trans what's the word I'm looking for testosterone has to be injected and if people are relying on black market hormones they also may be relying on or getting needles from not such scrupulous places so being aware that HIV and AIDS and blood-borne pathogens continue to be a major factor being a feminine is sometimes condemned in the gay community and this characteristic may add to a gay men's shame just knowing that so you don't assume that being a feminine is okay and that's not an issue at all just know that it could be bisexuals may feel alienated not just from the heterosexual community but also from lesbian and gay community so they internalize biphobia which results in a struggle towards self-acceptance for transgendered persons hormone therapy is often an overlooked issue hormone therapies now think about it if you've ever known anybody on hormone therapy whether they're taking testosterone injections or they're taking steroids or they're taking you know female hormones it affects mood and if it's taken improperly it can really dramatically affect mood and sometimes you know the prescription stuff can improve mood but it's important to understand that especially if they are on a hormone replacement or therapy for transgendered persons there's a lot of chaos going on in their body so they may have mood swings that they need to learn how to deal with transgender clients may face additional risks from using street or black market hormones and because testosterone must be injected obtaining or using needles may be relapsed triggers for clients in early recovery from IV drug use so if they were addicted to opiates or something that they were injecting it can be a relapse trigger LGBT individuals have been marginalized by some health professionals who historically labeled LGBT sexual orientation as deviant or pathological so a lot of times LGBT individuals may not disclose their sexual orientation to healthcare providers and especially unfortunately not mental health clinicians or psychologists because the big old DSM was pathologizing them for so long so this family acceptance project I told you there was an advocacy project that was working to help people who have children who begin to explore their identity as a sexual or gender minority the family acceptance project has identified a clear link between families rejecting reactions to sexual orientation and gender expression during adolescence and negative health and mental health outcomes kind of predictable there but not a surprise family acceptance project recognizes that parents and caregivers who are seen as rejecting their LGBT child are often motivated by care and concern to help their child fit in or have a good life and be accepted by others they want their child to be okay they want their child to be quote normal and they have difficulty understanding that their child can be LGBT QI2K and be normal understands that family behaviors are not isolated incidents but occur in a cultural context so it's not just one time mom says that you just can't be telling me that it's repeated messages that they get from mom and dad as they're growing up and even after they've come out aimed at socializing their children and adolescents to adapt and be successful in a heteronormative society these behaviors aim to protect their children from harm and victimization due to their LGBT identity and gender expression so a lot of times the things that we do inadvertently may be oppressive to our children if we don't recognize that they have a different sexual identity the family acceptance project uses research findings to link reactions to their child's identity with health mental health and well-being so we want to show them research says that if you have this reaction it's going to promote well-being so let's work for this reaction beyond building a strong alliance between families and providers family awareness of the consequences of negative behavioral reactions is the most important mechanism of change it helps parents understand that what they do and how they react and how they continue to react will continue to have an impact so yeah the initial reaction may not have been great but it's not too late they can back up they can you know begin accepting and supporting that person once they kind of catch their breath for a second parents and families often experience their lack of knowledge about LGBT issues as inadequacy that feels disempowering and shameful so think about when your kid has come to you with a problem you know we're supposed to be parents we're supposed to know how to fix it or know how to do whatever and if they come to you with a problem and we don't know what to do with it then we can feel very out of control and that's not a good feeling especially when you're dealing with your child's well-being so viewing it from that perspective what can I do to help you feel empowered what can I do to help you feel adequate as a parent many families perceive their LGBT identity as a loss particularly a loss of control over their child's future so differentiating loss it's not a loss in the I didn't have the child that I wanted it can be the loss of oh my gosh I cannot protect my child and I cannot you know help him avoid stigmatization provider should help families validate and address these feelings by affirming the importance of family support to build their child's self-esteem promote well-being and buffer rejection and negative reactions from others the family acceptance project recognizes that when rejecting and accepting behaviors coexist if they get rejecting in public and accepting at home or some things are rejected and other things are accepted or sometimes parents will accept their children but then they see something that is between a gay couple on TV and they make a negative comment or nonverbal it's confusing to the child so we want to help parents and families recognize that there is ambivalence there can be ambivalence but when there is ambivalence there's decreased support and increased risk for the child because the child's going okay so how do you really feel do you support me or was this reaction more actual to how you really feel inside education and learning their reactions and the effect of it that it has on their LGBT children can improve communication and help parents and caregivers respond in ways that help their LGBT child feel supported and loved rather than misunderstood or rejected you can read more about the project with this link so when you're working with LGBT clients and families there are some guidelines to kind of remember you want to demonstrate support and understanding for the client their spouse life partners and significant others there's no universal terminology regarding significant others in the LGBT community so ask again sometimes it comes down to asking what would you like me to call your partner your partner your your spouse your husband what term do you want me to use acknowledge the individual's self identification they self identify as bisexual or intersex or asexual this is what we're going to acknowledge and validate we need to be aware of biases that we don't we personally have regarding what a family should be like what does family mean does it mean you know two kids a dog and a white picket fence or does it mean an interaction where two people who love each other are coexisting or something else so what does a family mean understand the diversity and variety of relationships in the LGBT community and you could do an entire presentation on that and so it's important to recognize the different things and the spectrum of normal the spectrum of behaviors that goes on out there you would be surprised at how much BDSM and kink and things are out there and embraced by nearly a majority you know the numbers are getting much much higher especially since 50 shades of gray came out people have started becoming more open about their kink and about their sexual orientation and you know like I said media has also done a great job at helping people who are gay lesbian and transgender feel like they've got role models and they're accepted don't assume when you're working with these clients that there's no history of opposite sex relationships there probably is and it can be when they're still trying to figure out their identity but it could be that they had opposite sex relationships later on in life too for whatever reasons so we want to talk about those when you're using doing your assessments use culturally sensitive assessment measures avoid labeling your clients meet them where they are in the coming out process and respect their need to feel safe be guided by them listening to what they say is comfortable for them so if they say it's not comfortable to start making friends in the community that's okay what is comfortable for you what would you like to do for your next step what could help you learn more about this issue advocate and create safety for LGBT clients supporting and encouraging positive images of LGBT LGBT so within the media within social media within advertising I know who was it I'm thinking MTV had a very awesome transgender commercial that came out about a year ago I can't remember but it's important to support and encourage positive images develop a diversity preparedness plan for working with the LGBT community and in your course I have I found this checklist that was so awesome that was done by a school system and it's included in the additional resources but they worked on developing a diversity preparedness plan so it's one that you might use as a model for your own practice and work with the community to understand their particular needs and concerns for example I know there are some places in Texas and I'm thinking Austin is one of them where the LGBT community is huge and it's embraced there are drop-in centers there's lots of social activities and then there are other places where the LGBT community really doesn't have much in the way of resources and they have far different needs and concerns so being aware of what's true in your community is really important to your clients. Couple more things when you're taking a family history when you're working with all clients you're going to ask what were the rules of the family system? Was there a history of physical, emotional, sexual or spiritual trauma? Were all family members expected to evolve or behave in a certain way? And what were the family's expectations in regard to careers, relationships, appearance, status, or environment? Those are normal things that you're going to talk about with probably already on your assessment sheet. When you're working with LGBT clients you also may want to ask was anyone else in the family acknowledged to be or suspected of being a lesbian, gay, bisexual, or transgender? Because a lot of messages get communicated and kids even when they're little you know you're getting ready to go to a family reunion and the parents are talking and they hear stuff. They start getting those messages even when they're little about what's acceptable, what's not acceptable, what they think about, Aunt Sally, et cetera. How did the family respond to other individuals coming out or being identified as LGBT individuals? So they may hear about somebody in their church or in their community who's come out. What was their reaction? Is the client out to his or her family? That's obviously something we want to ask. And if the client is out, what type of response did he or she receive? So those are things that can help you get a better idea about what types of images and messages the person got and what the reception was like for them or if they haven't come out yet could indicate some of the reasons for internalized homophobia or fear of coming out. Now the sexual orientation assessment tool I do have time to click on this really quick. Again, this is in the document in the class online but I found it to be a really nice assessment tool. You have to scroll down to page 40. What page are we on? Okay, I thought it was paid page 40. Oh, that's page 72. Here we go. Coleman's assessment tool. It asks people to identify whether current relationship status is and so even in the assessment, you know, you can start putting out ideas and verbiage and hints what I'm can't find a word I'm looking for that being LGBT is okay. So what's your current living relationship? How do you define or how do you identify in terms of sexual orientation? In the future, how do you want to identify yourself? In terms of your comfort with your current sexual orientation, you know, how do you feel? And then it starts talking about up to the present time and in the future. So I was born a biological male or female up to the present time. And then in the future or in the ideal, I wish I had been born. So if they wish they had been born female, they could put that there and you can start looking about at the differences between where they are and how they identify right now and who they are and how they want to identify in the future. So this is free. It is part of your SAMHSA document that's in your classroom. Other resources, PFLAG, Parents, Families and Friends of Lesbian and Gays. They have a membership of over 200,000 people. ESHL is dedicated to the work of supporting Orthodox LGBTQ Jewish individuals in their desire to live fully in their religious and cultural traditions. Both of them have websites. There's also the National LGBT Health Education Center. MTV from the UK has an entire Pride section. SAMHSA, a provider's introduction to treatment for LGBT individuals. This one is old but it's the latest one that they have. There's another guide for understanding, supporting and affirming children, youth, and families. And an asset based approach for lesbian, gay, bisexual, transgender, questioning, intersex, and two-spirit youth and families in systems of care. So figuring out how to enhance assets within the system of care for this particular culture. I know I covered a bunch of stuff. Are there any questions? Alrighty, if there are none, you guys are good to go. Have an awesome weekend and I will see you on Tuesday. Thank you all for coming. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allCEUs.com slash Counselor Toolbox. This episode has been brought to you in part by AllCEUs.com providing 24-7 multimedia continuing education and pre-certification training to counselors, therapists, and nurses since 2006. Use coupon code Counselor Toolbox to get a 20% discount off your order this month.