1. Unifying science, education and service to transform lives Module 5 The Coming Out Process for Lesbians and Gay Men A Provider’s Introduction to Substance Abuse for Lesbian, Gay, Bisexual, and Transgender Individuals First Edition

2. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide to Working With Lesbian, Gay, Bisexual, and Transgender Clients in Substance Abuse Treatment 1. Understand the "coming out" process and its impact 2. Understand clinical issues and effective interventions with lesbians, gay men, bisexuals, transgender individuals, and LGBT youth 3. Have skills for working with LGBT families 4. Be able to identify and assess related health and mental health issues 5. Demonstrate skills for evaluating and improving counselor competence in treating LGBT clients Power Point Slide # 5-1

3. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Module # 5 – The Coming Out Process Learning Objectives Understand the coming out process Understand the coming out process Understand the connection between recovery and coming out Understand the connection between recovery and coming out Learn effective counselor interventions Learn effective counselor interventions Power Point Slide # 5-2

4. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide The Labeling Exercise You are at an important career-related networking function. You want to meet and greet every other person in the room at least once. You want to meet and greet every other person in the room at least once. Read the label on each person’s forehead and treat him or her according to what that label says Read the label on each person’s forehead and treat him or her according to what that label says. Power Point Slide # 5-3

5. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide 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. Power Point Slide # 5-4

6. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Stage I: Identity Confusion Occurs when a person begins to realize that he/she may relate to or identify as being gay or lesbian, a process of personalizing the identity. –Tasks: Exploration and increasing awareness –Feelings: Anxiety, confusion –Defenses:Denial –Recovery: Having a confidential support person Power Point Slide # 5-5 The CASS Model

7. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide (CASS Model continued) Occurs when a person accepts the possibility the he/she might be gay or lesbian. –Tasks: Exploration of implications, encountering others like oneself –Feelings: Anxiety, excitement –Defenses:Bargaining and rationalizing –Recovery:Meeting gays/ lesbians/ bisexuals/transgender persons in recovery Power Point Slide # 5-6 Stage II: Identity Comparison

8. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Stage III: Identity Tolerance Occurs when a person comes to accept the probability that he/she is an LGBT person. Tasks:Recognizing social and emotional needs as a gay man or lesbian Feelings: Anger, excitement Defenses:Reactivity Recovery:How to be gay, lesbian, bisexual, or transgender and stay sober Power Point Slide # 5-7

9. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Stage IV: Identity Acceptance Occurs when a person fully accepts rather than tolerates himself or herself as an LGBT person. Tasks:Development of community and acculturation Feelings: Rage and sadness Defenses: Hostility towards straight culture Recovery: Lesbian/gay/bisexual/ transgender recovering community building ) Power Point Slide # 5-8

10. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Stage V: Identity Pride Occurs when the person immerses himself or herself in the LGBT community and culture to live out identity totally Tasks:Full experience of being an LGBT person, confronting internalized homophobia Feelings: Excitement and focused anger Defenses: Arrogant pride and rejection of straight culture as the norm Recovery: Integrating sexuality, identity, and recovery Power Point Slide # 5-9

11. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Stage VI: 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. Tasks:Coming out as fully as possible, intimate gay and lesbian relationship; self-actualization as a gay man, lesbian, bisexual, or transgender person Feelings:Excitement and happiness Defenses:Minimal Recovery:Maintenance (end stage) Power Point Slide # 5-10

12. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Neisen's 3-Phase Model for Recovery From Shame – Phase I Breaking the Silence parallels the process of coming out. It is important for LGBT individuals to tell their stories and to address the pain of being different in a heterosexist society. Counselor Tasks: 1. Facilitate client discussion of hiding LGBT feelings from others 2. Explore emotional costs of hiding/denying one's sexuality 3. Discuss how the client has tried to fit in and at what cost 4. Examine negative feelings of self-blame, feeling bad or sick, and the effect of shaming messages on client 5. Foster client's ability to be out Power Point Slide # 5-11

13. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Phase Two: Establishing Perpetrator Responsibility Allows clients to understand their struggle in the context of societal discrimination and prejudice. Counselor Tasks Counselor Tasks: 1. Facilitate focusing and, managing anger constructively, not destructively 2. Help client understand and accept negative self-image as socio cultural, not personal 3. Counteract client's experience of heterosexism and homophobia by role-modeling and by providing a treatment environment that is empowering for LGBT persons, not stigmatizing. Power Point Slide # 5-12

14. Unifying science, education and services to transform lives. A Provider’s Introduction to Substance Abuse for LGBT Individuals Module 5 -12 Clinician’s Guide Phase Three: Reclaiming Personal Power Involves improving self-concept, self-esteem, and self- confidence Counselor Tasks Counselor Tasks: 1. Facilitate client's self-concept and self-efficacy 2. Identify and change negative messages to affirmations 3. Recognize and release residual shame 4. Develop a positive affirming spirituality 5. Integrate public and private identities 6. Build a support network, connect to community Power Point Slide # 5-13