1. CHAPTER 23 COUNSELING SEXUAL MINORITIES

2. Homosexuality  Homosexuality involves the affectional and/or sexual orientation to a person of the same sex  Most males prefer the term gay and females— lesbian  Approximately 4-10% of the U.S. population are homosexual  Younger Americans seem more accepting of gay rights and same sex marriages  However, violence and discrimination is pervasive

3. Homosexuals and Disorders  Same Sex Relationships Are Not Signs of Mental Disorders  Research supports that homosexuals are not more psychologically disturbed on account of their homosexuality  However, Lesbian and gay youth report elevated levels of major depression, generalized anxiety disorder and substance abuse

4. Assumption of Heterosexuality  It is important that counselors do not assume heterosexuality, not focus on the client’s sexual orientation if it is irrelevant, understand the “coming out” process, and infuse sexual orientation issues into training programs

5. GLBT Couples and Families  About 1.2 million people are part of gay and lesbian couples in the U.S.—a 300% increase since 1990  Children of GLBT couples show healthy cognitive and behavioral functioning  GLBT couples may be uncomfortable showing affection towards one another

6. GLBT Youth  Compared to heterosexual youth, GLBT youth report more substance abuse, sexual risk taking behaviors, suicidal attempts/thoughts and personal safety issues

7. Identity Issues Awareness of sexual orientation of gay males and lesbian females tends to occur in the early teens The struggle for identity involves one’s internal perceptions in contrast to the external perceptions or assumptions of others about one’s sexual orientation Individuals with gender identity issues report feeling “different” at an early age Cross-sex behaviors and appearance are highly stigmatized in school and society Mental health providers need to help GLBT youth to develop coping strategies and survival skills and to expand environmental supports

8. Coming Out The decision to come out can be extremely difficult Coming out to parents, family, and friends can lead to rejection, anger, and grief This can be especially difficult for adolescents who are financially dependent on their family Black and Latino gay and lesbian youth are more reluctant to disclose their sexual orientation than are their White counterparts A counselor should help GLBT individuals with the coming out process (e.g. decision-making, role plays) Mental health providers should assist GLBT individuals with acquiring social support

9. Guidelines for Clinical Practice Examine your own views regarding heterosexuality and determine their impact on work with GLBT clients--way to personalize this perspective is to assume that some of your family, friends or coworkers may be GLBT. Read the “Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients” (Division 44/Committee on Lesbian, Gay, and Bisexual Concerns, 2000) Develop partnerships, consultation, or collaborative efforts with local and national GLBT organizations Assure that your intake forms, interview procedures, and language are free of heterosexist bias and include a question on sexual behavior, attraction, or orientation Do not assume that the presenting problems necessarily are the result of sexual orientation but be willing to address possible societal issues and their role in the problems faced by GLBT clients.

10. Guidelines for Clinical Practice Remember that common mental health issues may include stress due to prejudice and discrimination; internalized homophobia; the coming out process; a lack of family, peer, school, and community supports; being a victim of assault; suicidal ideation or attempts; and substance abuse Realize that GLBT couples may have problems similar to those of their heterosexual counterparts but may also display unique concerns such differences in the degree of comfort with public demonstrations of their relationship or reactions from their family of origin Assess spiritual and religious needs

11. Guidelines for Clinical Practice Because many GLBT clients have internalized the societal belief that they cannot have long-lasting relationships, have materials available that portray healthy and satisfying GLBT relationships Recognize that a large number of GLBT clients have been subject to hate crimes--depression, anger, posttraumatic stress, and self-blame may result For clients still dealing with internalized homosexuality, help them establish a new affirming identity Remember that in group therapy, a GLBT individual may have specific concerns over confidentiality and different life stressors as compared with their heterosexual counterparts

12. Guidelines for Clinical Practice A number of therapeutic strategies can be useful with internalized homophobia, prejudice, and discrimination. They can include identifying and correcting cognitive distortions, coping skills training, assertiveness training, and utilizing social supports If necessary, take systems-level intervention to schools, employment, and religious organizations Conduct research on the mental health needs of the GLBT communities and the effectiveness of current programs