Tag Archives: LGBTQ Issues

LGBTQ Issues

The use of evidence-based practices with oppressed populations

By Geri Miller, Glenda S. Johnson, Mx. Tuesday Feral, William Luckett, Kelsey Fish and Madison Ericksen December 3, 2018

Therapy must always be tailored to the individual; there is no one-size-fits-all model. However, certain approaches have been empirically verified for use with a variety of clientele. It is critical that all counselors, especially those working with client populations that are oppressed, have both an overview of evidence-based practices and specific techniques related to these approaches in their clinical toolboxes to help them provide the best counseling services possible.

Counselors are frequently required to use evidence-based practices and need to know how to use them effectively in counseling clients who are oppressed. Specifically, the unique development of the therapeutic relationship between oppressed clients and privileged clinicians must be understood and addressed. Multicultural counseling experts Derald Wing Sue and David Sue maintain that the dynamics of oppression shift the influence of the therapeutic relationship. Thus, counselors must alter their application of evidence-based practice techniques.

Solution-focused brief therapy and low socioeconomic status

Take a moment to think about what the basic needs of your own life are. What is impossible for you to live without? For many of us, our basic needs are continually met. Therefore, they often go unnoticed — they are woven into our everyday lives and ways of being in the world.

For others, questions such as “Will I eat today?” or “Will I have a safe and warm place to sleep tonight?” are asked daily. Often, the answer is “no.” Concerns such as clean drinking water, access to hygiene products and finding adequate shelter affect an inordinate number of individuals in the United States. School counselors and licensed professional counselors have a moral and ethical obligation to address these matters, with the intention of removing barriers and cultivating a safe space for clients in both the therapeutic relationship and the environment beyond our office walls.

Glenda Johnson (one of the co-authors of this article) worked as a school counselor and an advocate in a school system in which the majority of students came from low socioeconomic status (SES) backgrounds. Many of the students were on free or reduced lunch plans because their families’ financial resources were severely limited. At the core of Johnson’s work was the intent to ensure that every child’s basic needs were met while they were at school. She emphasized the importance of working collaboratively with other school staff members to build a team and a foundation for connecting these students and their families to resources.

It is also vital to assess an individual’s behaviors, emotions and reactions through a holistic, biopsychosocial approach rather than focusing only on the school context. Learned behavior concerns, inattention, difficulty with emotion regulation (anger), sadness and loss of hope are often the result of a lack of resources. Johnson recalls that if a student acted out, one of her first questions would be, “Did you have breakfast this morning?”

Johnson shares an anecdote that highlights the powerful act of providing a safe, therapeutic space for students to identify and voice their emotions openly with peers. As a school counselor, she infused the identification of various emotions into a game of musical chairs, and what transpired was completely unexpected. A student identified a “sad” emotion and explained that their father recently had lost his job. The student was experiencing fear about not having enough food to eat during this time. Then, other students began to share similar stories without prompting. The game of musical chairs transformed into a collaborative and touching experience as the students identified common ground and connected on deeper levels of understanding and empathy.

When providing services to individuals from a low SES, counselors may find it helpful to use a strengths-based therapeutic approach. The evidence-based practice of solution-focused brief therapy (SFBT) zeros in on the therapeutic relationship and the clinician’s way of being. In this relationship, there is an acknowledgment of reality but also an emphasis on solution-focused thought and reframing. Focusing on strengths, the counselor and client work together to identify and move toward making small changes in any area because a small change in one area often leads to change in another area.

SFBT often introduces the “miracle” question: “Suppose that when you go to sleep tonight, a miracle occurs that solves your problem, but because you were sleeping, you did not realize what happened. When you wake up in the morning, how will you realize a miracle happened? What will you notice that you are doing differently?” These questions enhance and expose glimpses of solutions that an individual may struggle to identify in everyday life situations.

Additionally, SFBT places great value on successes. The counselor and client celebrate achievement and may use scaling to note the client’s progress. When working in a school system, the counselor could develop a creative and motivating way for children to rate themselves and their progress toward goals. For example, Johnson created a rating scale, complemented by the colors green, yellow and red, for kindergartners and first-graders. Green identified a completed goal, yellow identified progress toward a goal and red identified room for improvement. Similarly, she used a rating scale of 1-5 for students in second through fourth grades. Under this scenario, a student could check in with a rating, such as, “I am at a 3 and working toward a 5.” The counselor might respond, “What would it take to get to a 3.5?” The scale provided a visual for children to identify, track and celebrate their successes.

In SFBT, the counselor acknowledges client strengths and walks alongside these clients as they create and work toward their goals and future successes. “Flagging the minefield” is another technique counselors can introduce to help clients generalize and apply what they learn in counseling to future situations. Flagging the minefield is a particularly important facet of SFBT because it assists individuals in recognizing potential obstacles or barriers that will appear in their lives. The counselor and client work together to identify tools and resources the client can apply in other settings and relationships.

When working with students living in poverty, counselors should introduce a strengths-based approach and identify and gather resources to assist students and their families in removing barriers and meeting basic needs. Cultivating a safe, therapeutic relationship with students that focuses on solution building can assist them in building a stronger sense of self.

Motivational interviewing, SFBT and rural adolescent substance abusers

Adolescence is a vulnerable time and a critical period for developmental outcomes. During this stage of life, adolescents are exploring and forming their peer relationships and personal identities while beginning to distance themselves from family. Experimentation with substances often begins during this time. In 2012, Tara Carney and Bronwyn Myers found a correlation between the early onset of substance use and an elevated risk for later development of substance use disorders. Additionally, because early substance use may impact the growth of the adolescent brain, it has the potential to heighten one’s risk for delayed social and academic development.

Adolescents living in rural areas are marginalized in multiple ways. Children are an underserved minority population, as are rural populations. Sheryl Kataoka, Lilly Zhang and Kenneth Wells (2002) found that among youth with a recognized mental health need (estimated at 10 million to 15 million people), only 20-30 percent receive specialized mental health care. Rural communities are more likely to have fewer clinicians or require a long drive to see those clinicians, making it more difficult to obtain care. These disadvantages are exacerbated by the tumultuous nature of adolescence.

Motivational interviewing and brief interventions are two evidence-based practices particularly suited to this population because these approaches are generally influential in their therapeutic role while also being cost-effective. Motivational interviewing facilitates behavior change through exploration and resolution of ambivalence, and it focuses on being optimistic, hopeful and strengths-based. It uses principles of empathy, discrepancy, self-efficacy and resistance, and offers specific techniques such as OARS (Open questions, Affirmations, Reflective listening, Summarizing). SFBT emphasizes solutions, changes clients’ perceptions and behaviors, helps clients access their strengths and uses techniques such as exception to the problem, specification of goals and the miracle question.

Individual interventions with the use of the same interventions for multiple sessions are ideal, and research suggests that the earlier the intervention, the better the outcome. Early intervention shows better results than both preventive measures and later interventions because it reduces the need for more specialized interventions and provides applicable and useful tools and tactics for adolescents as they enter into various student, peer, familial and professional roles.

Challenges certainly exist when working with children and adolescents, particularly because many biological, environmental and social shifts occur organically during this time. As children and adolescents rapidly transition on a continuum of development, they become “moving targets.” Interventions that prove effective for those ages 11-12 often cease to be effective by ages 13 or 14. It is vital that counselors remain aware of this across the life span. Although adolescents are beginning to distance themselves from their caregivers, familial relationships and parental involvement remain crucial during this period.

To appropriately and competently involve the families of rural adolescents, some understanding of cultural values is necessary. In 2005, Susan Keefe and Susie Greene identified core Appalachian values, including egalitarianism, personalism, familism, a religious worldview, a strong sense of place and the avoidance of conflict. In the Appalachian region, assuming authority without demonstrating an authoritarian attitude is important. Language tends to be simple, direct, honest and straightforward. Family is extremely important, exemplified by the adage “blood is thicker than water.” Individuals’ relationship to the land is complex, and it can be beneficial to explore how clients view economic deprivation. In 2016, Sue and Sue also pinpointed some tendencies of rural clients, including having a “street-smart” attitude and way of being, depending on systems due to living in poverty and valuing survival at all costs.

As a result, subtle techniques such as stages of change, motivational interviewing and SFBT may be useful for this population. In stages of change, the intervention is matched to the stage of the client’s readiness to change (precontemplation, contemplation, preparation, action, maintenance, termination). Motivational interviewing facilitates an invitation to engage, and its strengths-based, hopeful tone can be helpful for clients living in an environment populated by deficits such as poverty and lack of education. The practical nature of brief therapy fits well with the no-nonsense worldview of clients coming from rural backgrounds.

Unfortunately, published rural studies often focus on specific regions or populations. Few interventions have been tested in rural settings, and the evidence from systematic reviews is often too general and not specific to the rural context. Ideally, rural communities could review interventions tested with various target populations in a range of settings. Such information is not usually available, however, and the strength of evidence is unlikely to be the only factor considered in choosing an intervention. The research on rural adolescent populations is limited, and little consistency exists across studies related to measurement tools. Furthermore, disseminating evidence-based practices to schools, families and community settings in rural areas is difficult due to the lack of resources.

However, it is important to note that there have been great improvements in substance abuse treatment and prevention with children and adolescents who live in rural areas. A 2016 Monitoring the Future survey of eighth-, 10th- and 12th-graders by the National Institute on Drug Abuse found the lowest ever reported rates of use for all illicit drugs, including alcohol, marijuana and nicotine. As further research is conducted, it will be important to delve into this information to identify what is already working with these individuals and what can be improved to better serve them moving forward.

Evidence-based practices with transgender clients

Transgender individuals face discrimination on multiple fronts. Many experience familial rejection, unequal treatment, harassment and physical violence during daily living. The rate of substance abuse within the transgender community is three times higher than that of the general population. There is a profound lack of competent health care for transgender individuals, and the care that is available may be inaccessible to a majority of the transgender population. The rate of unemployment within the transgender community is also three times greater than that of the general population, due in part to factors such as workplace discrimination, poverty and homelessness. Transgender people also face discrimination and mistreatment in shelters.

With high rates of homelessness, substance abuse and mistreatment, transgender people also have frequent interactions with law enforcement, where they can be subject to police brutality and discrimination. Within the criminal justice system, a high rate of physical and sexual assault is perpetrated against transgender individuals, and they are often denied medical treatment while incarcerated or detained.

Poor health outcomes for transgender people correlate with risk factors such as economic and housing instability, lower educational attainment, lack of family support and other intersectional factors such as race, ethnicity, immigration status and ability.

According to the 2015 U.S. Transgender Survey, 18 percent of transgender people who sought mental health services experienced a mental health professional attempt to stop them from being transgender. This correlated with higher rates of serious psychological distress and suicide attempts and an increased likelihood of running away from home, homelessness and engaging in sex work.

Research conducted in 2015 by Samantha Pflum et al. emphasized the lack of access to transgender-affirming resources and communities for individuals living in rural locations. The history of mistreatment and abuse of lesbian, gay, bisexual, transgender and gender-nonconforming clients by medical and mental health professionals must be acknowledged. Gender and sexual minority clients still face discrimination within the helping professions, and for individuals holding multiple marginalized identities, these experiences are compounded.

Even well-meaning providers are likely to make mistakes when working with marginalized clients. According to Lauren Mizock and Christine Lundquist, one of these mistakes is education burdening, or relying on the client to educate the provider about transgender culture or the general transgender experience. Resources exist to facilitate competence in these areas, and clinicians have a responsibility to refrain from placing the burden of their education on the client.

Some counselors participate in gender inflation, or focusing on the client’s gender to the exclusion of other important factors. Other counselors engage in gender narrowing, applying restrictive, preconceived ideas about gender to the client, or gender avoidance, which involves ignoring issues of gender altogether. Gender generalizing occurs when a clinician assumes that all transgender clients are similar. Gender repairing operates from a belief that a transgender identity is a problem to be “fixed.” Gender pathologizing involves viewing transgender identity as a mental illness or as the cause of the client’s issues. Finally, gatekeeping occurs when a provider controls client access to gender-affirming resources.

Acceptance of a client’s gender identity is ultimately not enough to provide competent, affirmative services. Understanding the nuances of these common mistakes will help clinicians provide a safe therapeutic environment that is affirming of these clients’ identity and humanity.

The Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC), a division of the American Counseling Association, has developed competencies for counseling transgender clients (see counseling.org/knowledge-center/competencies) that focus on the following eight domains:

  • Human growth and development
  • Social and cultural foundations
  • Helping relationships
  • Group work
  • Professional orientation
  • Career and lifestyle development competencies
  • Appraisal
  • Research

Counselors can work within this framework to:

  • Promote resilience by using theoretical approaches grounded in resilience and wellness
  • Conceptualize the development of a transgender individual across the life span
  • Understand internal and external factors influencing identity development
  • Consider how identity interacts with systems of power and oppression (especially for minority transgender individuals)
  • Examine counselors’ own internalized beliefs and how those beliefs affect attitudes toward transgender clients
  • Reevaluate approaches to working with transgender clients as new research emerges

One intervention that has been identified for use with this population by Ashley Austin and Shelley Craig is transgender-affirmative cognitive behavior therapy (CBT). Transgender-affirmative CBT modifies CBT interventions to address specific minority stressors, such as victimization, harassment, violence, discrimination and microaggressions, that transgender people commonly face. This approach uses psychoeducation to help clients understand the connections between transphobic experiences and mental health issues such as stress, anxiety, depression, hopelessness and suicidality. Experiences are processed through a minority stress lens to help clients move from a pathologizing-of-self mindset to an affirming view of themselves as people coping with complex circumstances.

Clinicians are advised to affirm the existence of discrimination and to help these clients identify influences on their mental health by using the transgender discrimination inverted pyramid (see below). 

Transgender individuals internalize messages at each level, and it can be beneficial to have a visual for how these messages trickle down and influence mental health. Clinicians can empower transgender clients by assisting them in challenging internal and societal transphobic barriers. A few examples are challenging negative self-beliefs, connecting with a supportive community and advocating for self and community.

Another approach recommended for use with transgender clients by Joseph Avera et al. in 2015 is the Indivisible Self model, an Adlerian wellness model refined by Jane Myers and Thomas Sweeney that emphasizes strengths. There are five wellness factors of self in this model:

  • Creative Self: Cognitions, emotions, humor and work
  • Coping Self: Stress management, self-worth, realistic beliefs and leisure
  • Social Self: Friends, family and love)
  • Essential Self: Spirituality, self-care, gender identity and cultural identity
  • Physical Self: Physical and nutritional wellness

This model easily can be adapted to a transgender-specific lens, especially regarding the Essential Self, by exploring gender and cultural identity and how they influence client experiences and beliefs. Used in conjunction with the ALGBTIC transgender competencies, the Indivisible Self model offers helping professionals both a conceptual and practical framework for working effectively with transgender clients.

For all clients, and transgender clients in particular, intersectional factors magnify the experience of oppression. Sand Chang and Anneliese Singh recommend addressing the intersectionality of race/ethnicity and gender identity for both clients and clinicians. This involves:

  • Challenging assumptions about the experiences of transgender and gender-nonconforming people of color
  • Building rapport and acknowledging differences within the therapeutic dyad
  • Assessing client strengths and resilience in navigating multiple oppressions
  • Providing a variety of resources that are affirming to transgender and gender-nonconforming people of color

In addition, assisting clients in locating social support is advised. Social support increases healthy coping mechanisms and helps with self-acceptance, thereby reducing psychological stress related to discrimination. Social support can also help to normalize and validate emotions related to discrimination.

Conclusion

Evidence-based practices have consistently been shown to be helpful to clients, but counselors must remember that they operate within the context of a relationship. To use evidence-based practices effectively, we must hold on to our humanness. The implementation of a single technique will look very different depending on who is in the room and what they are bringing with them.

Often, the expectations for using evidence-based practices might create pressure for counselors to follow a strict formula for treatment. Process variables such as honoring the personal relationship between the counselor and the client, maintaining a “therapist’s heart” and respecting the unique aspects of the client may seem to be at odds with the procedure for using a specific intervention. A working knowledge of multicultural issues can provide some context for how to shift evidence-based practices to fit the client rather than pressuring the client to conform to a prescribed, generalized format.

Using interventions with a solid evidence base is good practice. Adjusting their implementation on the basis of the unique identity of the person sitting across from us is great practice.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Geri Miller is a professor in the Department of Human Development and Psychological Counseling (clinical mental health counseling track) at Appalachian State University (ASU) in North Carolina. She is a licensed professional counselor, licensed psychologist, licensed clinical addictions specialist and substance abuse professional practice board certified clinical supervisor. She has been a volunteer counselor at a local health department since the early 1990s. Her clientele has primarily consisted of women with little opportunity for jobs or education and who experience barriers of poverty. Contact her at millerga@appstate.edu.

Glenda S. Johnson is an assistant professor in the Department of Human Development and Psychological Counseling (school counseling program) at ASU. She is a licensed professional counselor and a licensed school counselor in North Carolina. Her scholarly focus includes school counselors delivering comprehensive school counseling programs, students who are at risk of dropping out of high school and the mentoring of new counseling professionals.

Mx. Tuesday Feral received their master’s degree in clinical mental health counseling and a certificate in systematic multicultural counseling from ASU. They are the support programs director for Tranzmission, a nonprofit organization serving the Western North Carolina nonbinary and transgender community through education, advocacy and support services. Tuesday offers training and workshops in trans cultural competence and cultural humility on local, state and national levels.

William Luckett received his master’s degree in clinical mental health counseling from ASU with a certificate in addictions counseling. He has interests in somatic therapy approaches, mindfulness, religious and spiritual topics in counseling, and substance abuse counseling. He currently provides in-home counseling to rural families in Virginia.

Kelsey Fish is a student in ASU’s clinical mental health counseling program and a clinical intern with Daymark Recovery Services in rural Appalachia. Her clinical interests include expressive arts therapy, adolescents, and gender and sexual minority issues.

Madison Ericksen is a graduate of the clinical mental health counseling program at ASU. She has specialized training and interest in trauma-informed practices that use mindfulness, eco-based and expressive art therapies as complementary treatments alongside traditional therapy. She provides strengths-based and resiliency-focused outpatient counseling for children and families.

 

Letters to the editor:  ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Promoting LGBTQ students’ well-being in schools

By Roberto L. Abreu, Adriana G. McEachern, Jennifer Geddes Hall and Maureen C. Kenny October 2, 2018

Research shows that LGBTQ youth are disproportionately bullied (whether in person or via cyberbullying), verbally and physically harassed, and assaulted in schools by peers and staff. Such hostility has been correlated to lower school performance and psychological and emotional distress, including suicidal ideation and attempt, depression and anxiety.

In the 2015 GLSEN (formerly Gay, Lesbian & Straight Education Network) National School Climate Survey, LGB students reported higher levels of verbal, physical and sexual violence and bullying than did their heterosexual counterparts. Specifically, 98.1 percent of LGB students heard the word “gay” used in a derogatory manner, 85.2 percent reported verbal harassment, and 34.7 percent reported being physically harassed in the past year. In addition, a 2017 meta-analysis (conducted by co-authors Roberto L. Abreu and Maureen C. Kenny) of 27 empirical studies on the effects of cyberbullying on LGBTQ youth revealed that compared with their heterosexual and cisgender counterparts, these students are disproportionately harassed online and through other technology-based means. Such harassment has been correlated to a range of behavioral and emotional difficulties, including suicidal ideation (with some studies suggesting rates as high as 40 percent among LGBTQ youth) and suicide attempts (with rates as high as 30 percent).

Many LGBTQ students identify school counselors as the one school staff member to whom they are most likely to disclose concerns related to their sexual and gender identity. Given this reality, school counselors are uniquely positioned to address myths about LGBTQ youth, to advocate for these students and to effect change.

Dispelling myths

Let’s begin by examining five myths that can have an impact on the identity, safety and well-being of LGBTQ youth. We’ll also look at specific strategies and interventions that counselors can use to address these myths and increase the safety of LGBTQ students.

Myth #1: Parents must be informed of their child’s sexual and gender identity. A 10th-grader discloses to her high school counselor that she identifies as a lesbian. Most of her friends know, but she has yet to tell her parents. She fears their reaction because she has heard them make derogatory remarks toward LGBTQ individuals in the past. Must the school counselor inform the student’s parents?

The American School Counselor Association (ASCA) National Model (2012) stresses the importance of parent and family involvement and its influence on the well-being of students. Although parent engagement is critical when working with LGBTQ youth, school counselors should consider several factors before disclosing to parents a student’s sexual or gender identity. Many LGBTQ students believe they lack parental support, and they may fear rejection, abuse and an unsafe home environment if their parents discover their sexual or gender identity.

Therefore, the counselor in this scenario should first discuss with the student her feelings about informing her parents and assess how they may react to this information. It would be important for the counselor to prepare the student for potential negative parental responses. Role-playing the conversation could be helpful for the student. It would be best to have the minor client make the disclosure to her parents with the counselor present to provide support. It is also important to have a plan in place to provide the client with a safe place to stay should the parents totally reject her and need time to adjust to the situation.

In certain instances, school counselors may have to break confidentiality. For example, what if the student also disclosed to the counselor that she was distraught over the situation and was having suicidal thoughts and feelings of hopelessness because she feared that her parents would never understand or accept her sexual and gender identity? In that situation, there would be potential harm and danger to the minor client. Therefore, the counselor would need to conduct a thorough suicide assessment, then inform the client of the legal and ethical reasons that confidentiality must be breached.

It is important for counselors to check their schools’ policies and procedures in relation to dealing with crisis situations such as suicide. School counselors can work with parents individually or in groups to foster awareness and acceptance of LGBTQ students and to promote understanding of their needs and the challenges these students face every day.

Myth #2: Gender-neutral facilities are a threat to school safety. A school district policy does not allow transgender students to use the restroom that corresponds to their gender identity. A transgender student has brought this to the attention of the school counselor, inquiring about what to do. The student says he often goes the entire school day without going to the restroom.

School counselors should use their role as staff and educators to speak to the school administration about this issue. In talking to school administrators, counselors can present research related to transgender students experiencing a lack of safety in schools and make the argument that forcing these students to use a bathroom that does not align with their gender identity only contributes to this presenting concern.

Some states have passed laws precluding gender-neutral facilities, imposing on the rights of transgender individuals to use the restroom that corresponds to their gender identity rather than their sex at birth. Some of these laws have been incorporated into school policy. The rationale given for these laws has been to protect public privacy and safety. However, there is no research evidence to support this claim.

In 2015, Media Matters for America conducted a survey of 17 school districts in 12 states encompassing approximately 600,000 students. The survey asked about cases of harassment or inappropriate behavior after transgender-inclusive policies had been passed in those districts. The survey results concluded that no incidents of sexual harassment or inappropriate behavior had been reported in those schools, debunking the myth that gender-neutral facilities are a threat to school safety.

Counselors, as social justice agents, must involve themselves in policy. This can be done at school meetings, where counselors can advocate for gender-neutral policies in schools and school districts. Counselors can inform school administrators of their interest in participating in these meetings and being involved in the decision-making process. They can volunteer to conduct information sessions for meeting participants about the academic, personal and career needs of LGBTQ youth. Counselors should actively seek to advocate for transgender youth so that these students can use the bathroom that best aligns with their gender.

Myth #3: School policies and laws protect all students. School policies and laws have focused mainly on reducing bullying but not necessarily on protecting LGBTQ youth and keeping them safe. The 2015 GLSEN report that investigated anti-bullying policies in the nation’s school districts revealed that out of the 13,181 school districts surveyed, 70 percent had anti-bullying policies. However, only 20 percent of these school districts had LGB-inclusive policies, and only 10 percent had LGBT-inclusive anti-bullying policies.

Although anti-bullying policies may be in place, LGBTQ students continue to report higher incidents of bullying and harassment than do other students. Often, these policies are not widely distributed to students and staff, and although most students and staff may be aware of district anti-bullying policies, they are not necessarily aware of LGBT-inclusive anti-bullying policies. 

Furthermore, policies and laws are often influenced by politics and societal opinions. Laws referred to as “no promo homo” involve efforts to prevent national LGBT education, mandate that administrators take a neutral stance on gender identity and prohibit providing specific services to these students. Although seven states (Alabama, Arizona, Louisiana, Mississippi, Oklahoma, South Carolina and Texas) had “no promo homo” laws as of January 2018, many states are working to develop LGBT-inclusive laws and policies that do not discriminate against these youth. For example, many states have developed LGBT anti-discrimination laws. These laws also permit transgender students to participate in sports congruent with their gender identity.

School counselors need to be proactive and work with school administrators to develop LGBT-inclusive policies. Counselors can assist in disseminating and discussing these policies regularly with students, parents and staff. Counselors should educate school administrators on bullying and “no promo homo” laws so they will better understand the detrimental effects of systemic oppression on LGBT youth.

In addition, school counselors should empower LGBTQ students to share with school staff their experiences with bullying and harassment within the school. This will open the door for school personnel to make a personal connection with these students and will help them learn more about the physical and mental health consequences of LGBTQ bullying and lack of representation.

Myth #4: LGBTQ students are safe around all school personnel. Many LGBTQ students do not feel safe at school — around either other students or school personnel. The GLSEN survey from 2015 reported that more than 50 percent of LGBTQ students heard homophobic comments from teachers and school staff. Many of these students believed that reporting harassment or assaults to school personnel would worsen the situation and that no action would be taken. Among those who did disclose bullying, harassment or assault to school staff, 63.5 percent indicated that their reports were ignored. In addition, when these incidents were reported, LGBTQ students faced harsher discipline than did their heterosexual and cisgender peers and were often blamed for the incidents (see research from Shannon Snapp, Jennifer Hoenig, Amanda Fields and Stephen Russell). This lack of support from school personnel places LGBTQ students at greater risk of being victimized.

In 2017, students in California’s San Luis Obispo High School published an edition of the student paper, Expressions, featuring LGBTQ issues. In response, a special education teacher at the school wrote a letter quoting the Bible and stating that those committing homosexual acts “deserve to die.” The school administration chose not to discipline the teacher for the action, stating that teachers as well as students “do not shed their First Amendment rights” at school. Although the teacher resigned soon after the incident, his statement remains a testament to the harassment and discrimination leveled against some LGBTQ students by school personnel.

School counselors need to advocate for and support LGBTQ students in the face of such victimization. Providing training to all students, parents and school staff is critical to reducing incidents of bullying and harassment and increasing awareness and sensitivity to the issues LGBTQ students confront in schools. A middle school in South Florida developed a monthlong program that focused on bullying prevention, including sexual and gender identity sensitivity training at various levels. At the high school level, counselors are forming LGBTQ support groups to provide outlets for these students to discuss specific issues and concerns. These groups provide one way to let these students know that they are valued and that their voices are important.

Myth #5: Sex education is inclusive of all students. Sex education that is LGBTQ inclusive is very limited or nonexistent in our nation’s schools. Often, this lack of inclusion is due to discomfort and lack of knowledge about LGBTQ sexuality on the part of school personnel, students and parents. Many teachers do not feel competent to teach on the topic.

Traditionally, sex education in U.S. schools centered on an abstinence-only curriculum. This ideology changed somewhat in the 1980s because of the AIDS epidemic, the increase in sexually transmitted diseases and teen pregnancy. The curriculum during this time focused on prevention and contraception, but no content was included on LGBTQ sexuality. In the 1990s, there was an effort to develop national guidelines for comprehensive sex education by the Sexuality Information and Education Council of the United States, a task force composed of educators and health professionals. However, these guidelines also lacked specific and clear directives on how to address the needs of LGBTQ students in schools.

Health care reform legislation in 2010 provided states with funding to draft comprehensive sex education in schools. One of the programs created from this initiative was the Personal Responsibility Education Program for young adults. Once again, however, this program
failed to offer educational content or policy language that was inclusive of LGBTQ students.

Given this reality, school counselors can take leadership roles in advocating to administrators and teachers on the importance of including educational information and materials about LGBTQ sexuality in the sex education curriculum. Counselors may need to ensure that the programs being used to teach sexuality are inclusive. Counselors can assist health educators by providing appropriate materials (see hrc.org/resources/a-call-to-action-lgbtq-youth-need-inclusive-sex-education for more information on LGBTQ-inclusive sex education). Counselors can also conduct psychoeducational workshops to dispel myths and misconceptions regarding LGBTQ students with all stakeholders, including students, school staff and parents.

 

A call to action

Clearly, the perpetuation of these myths indicates that something more needs to be done to better support LGBTQ students within school systems. School counselors, as outlined by ASCA, have an ethical obligation to support underserved and oppressed populations. Additionally, school counselor training programs emphasize the role of school counselors as agents of change within the school system and professional leaders who must act as allies and advocates for all students.

This role includes:

  • Being aware of the challenges that LGBTQ students face within the school system
  • Designing a developmental, comprehensive school counseling program to support the LGBTQ student population
  • Advocating for policies and practices that address inequities regarding academic, career and social/emotional domains for LGBTQ students 

Therefore, supporting LGBTQ students and promoting social justice initiatives should be done through large-scale, small-scale and individual interventions in an effort to create a positive school climate for everyone.

Readiness assessment

The first step is to conduct a needs and readiness assessment. This assessment should focus on gauging the school’s current climate related to LGBTQ students and the willingness of staff to make needed changes. Assessments should target students, faculty, staff and parents. Their openness toward acceptance and making changes, as well as the amount of education and training they have received related to LGBTQ populations, is important to assess.

Parents and school personnel may be reluctant to support LGBTQ youth in part because they do not feel prepared to respond to the unique needs of these students. School counselors will need to collaborate and discuss concerns with all stakeholders to comprehensively make appropriate systemic changes. These conversations also allow school counselors to gain awareness of current school policies and procedures related to the treatment of LGBTQ students.

Additionally, before changes can begin, school counselors should collect data that may be reflective of disparities and issues that LGBTQ students face within the school. Such data may include behavioral referrals, truancy rates and negative changes in grades and attitudes/behaviors. Behavioral referrals should be more specific and include incidents of verbal and physical harassment that LGBTQ students have endured as well as LGBTQ students who might be “acting out” in class in reaction to bullying or oppressive interactions.

LGBTQ students who are lacking support and involved with negative interactions often are truant, report somatic complaints and disengage from the learning process. It is therefore important that school counselors collect and examine data concerning absenteeism, visits to the school nurse, incidents of skipping class and dropping grades. This data should be saved and used as well during the measurement of formative and summative program success. This information will help inform what needs exist and how the school can best support LGBTQ students in dealing with their struggles.

It is important to note here that when collecting and analyzing data, counselors should look for patterns and then meet with students individually, regardless of their sexual or gender identity. At the time of this meeting, if the student discloses that their struggles are indeed related to their LGBTQ identity (for example, they are being bullied because of their gender expression), then counselors should move forward with interventions while making sure to protect the student’s confidentiality.

Intervention formulation

After school counselors have conducted a thorough assessment of their schools’ climate and needs, they can begin to formulate interventions and adjust policies to better support LGBTQ students. School counselors should include LGBTQ community members on their advisory boards to assist with inclusivity when promoting change and programming. Change and programming should include interventions at the schoolwide, small group and individual levels. 

Schoolwide interventions addressing bullying and diversity have been deemed most effective in promoting a more positive school environment for all students. These interventions should include procedures and programming specific to the LGBTQ population, such as staff training on LGBTQ issues, multicultural awareness and response procedures regarding victimization of LGBTQ students. Schoolwide strategies and policies to address LGBTQ-specific bullying and harassment must also be outlined.

Schools are also encouraged to provide educational workshops for parents that address issues related to sexual and gender identity, ways of talking at home about bullying (with both victims and perpetrators), and ways to discuss diversity and acceptance beyond the school setting. These conversations should include information that is pertinent and specific to LGBTQ students.

As a universal approach, teachers should be encouraged to incorporate LGBTQ-affirming curricula into their existing core areas of focus at the elementary, middle and high school levels as developmentally appropriate. School counselors also need to include examples of LGBTQ populations and the issues they face in classroom guidance lessons and when promoting positive behavior intervention and character education programs at their schools. Positive recognition of LGBTQ students, parents, staff and community members can also help to promote a more accepting environment overall. Additionally, it is beneficial to foster support from those involved in athletics and other extracurricular activities. This includes recruiting the active assistance and endorsement of coaches and athletes regarding LGBTQ students.

In addition to schoolwide interventions, schools can better support LGBTQ students by providing small group and individual services designed specifically for them. Safe zones/diversity rooms can be designated to serve as a resource for LGBTQ student needs or concerns. These spaces should be run by the school counselor or other trained staff and must respect the confidentiality of the students who use them. These spaces can serve as a safe, supportive environment for LGBTQ and other students to discuss issues they are facing. In addition, they can serve as resource rooms stocked with helpful books, flyers and other materials.

School counselors can also facilitate support groups specifically for LGBTQ students, allowing them to openly discuss their experiences, process their thoughts and feelings, and develop coping strategies. Group topics could include local and national resources available for LGBTQ individuals, LGBTQ role models, family relationships, intimate relationships, coming out, personal and professional issues that LGBTQ individuals encounter, and information about higher education institutions that are affirming of LGBTQ individuals.

Support groups for parents of LGBTQ students should also be offered. These groups would address ways for these parents to support their children. The groups would also provide a forum for parents to share their experiences and concerns with each other and with the school. In addition, many schools now offer a Gay-Straight Alliance (GSA), a student-led organization with a faculty adviser that typically meets to learn about issues that LGBTQ students are facing. GSA is meant to be a group that promotes acceptance, social justice and advocacy. 

School counselors also make themselves available to all students for individual counseling. In many cases, they may be the only mental health professional that students have easy access to for support. It is therefore imperative that school counselors demonstrate cultural competency and provide a safe, affirming environment that includes acceptance and respect for all students.

School counselors need to be aware that LGBTQ students may not present with problems related to their sexuality or gender identity. School counselors also need to consider other contextual factors such as family dynamics when counseling LGBTQ students. In addition to providing leadership toward systemic change, counselors need to have an understanding of issues that specifically affect LGBTQ students on an individual basis. This understanding is achieved through an ongoing process that includes communicating with the local LGBTQ community, participating in continuing education opportunities about LGBTQ students, reading the latest research related to this population and familiarizing themselves with the legal and ethical mandates surrounding LGBTQ students. Most important, school counselors must engage in ongoing self-examination of their own biases, stereotypes and blind spots concerning all students.

The role of school counselors in advocating for LGBTQ students in school is critical. It is school counselors’ professional and ethical responsibility to ensure a safe and harassment-free learning environment for all youth. Connecting with parents and educating them on the continuum of gender and sexual identity can also be an important part of the process. Given counselors’ expertise and skills in supporting diversity and communicating difficult topics, they can play a central role in helping staff, administrators and students create schools that empower LGBTQ youth.

 

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Recommended resources from the authors

  • A Queer Endeavor (aqueerendeavor.org): This site provides educators, school staff, families and students with resources (videos, lesson plans, curriculum development best practices, textbook recommendations) to help support and create an inclusive school environment for sexual minority and gender-expansive students.
  • GLSEN Educator Resources (glsen.org/educate/resources): GLSEN is one of the nation’s largest advocacy groups focused on providing resources that promote the well-being of sexual minority and gender-expansive students in grades K-12. This site provides tools for schoolwide advocacy programming and lesson plans that are LGBTQ inclusive.
  • It’s Pronounced Metrosexual (itspronouncedmetrosexual.com): This site provides online resources (worksheets, videos, articles, books) about privilege and oppression overall, with an emphasis on educating society about topics related to sexual and gender identity. The site serves as a source of information for social justice advocates, researchers and clinicians.
  • American Psychological Association (APA) Safe and Supportive Schools Project (apa.org/pi/lgbt/programs/safe-supportive/default.aspx): APA’s Safe and Supportive Schools Project partners with five professional organizations, including the American Counseling Association and ASCA, to provide training and educational resources. The goal is to help school personnel, leaders of community organizations, parents and students to build positive, supportive and healthy environments that promote acceptance, allowing LGBTQ youth to thrive as their authentic selves.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Roberto L. Abreu is an assistant professor of counseling psychology at Tennessee State University. His research agenda focuses on the well-being of LGBTQ people of color, with specific attention to parental, school and community acceptance of Latinx LGBTQ youth. Contact him at rabreu@tnstate.edu.

Adriana G. McEachern is a professor emerita, a visiting associate professor and the program director for counselor education in the Department of Leadership and Professional Studies at Florida International University. She is a national certified counselor, certified rehabilitation counselor and licensed mental health counselor in Florida.

Jennifer Geddes Hall is a clinical assistant professor at Clemson University and a licensed professional counselor. She has more than 15 years’ experience working with children and teenagers as a school counselor and clinical mental health counselor in various community settings.

Maureen C. Kenny is a professor of counseling at Florida International University and director of the university’s clinical mental health counseling program.

 

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

In search of an affirming faith

By Laurie Meyers July 25, 2018

One of Cyndi Matthews’ most vivid memories of growing up in a fundamentalist Christian church was watching the minister point at her brother’s best friend during a service and say, “You don’t belong here. Get out.” The reason? The boy was gay.

Matthews, a licensed professional counselor supervisor (LPC-S), says that incident was her first glimpse of a pattern of spiritual abuse directed at congregation members who identified as lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ). The animosity that leaders of the church held for LGBTQ members did not fit Matthews’ conception of Christianity. This religious cognitive dissonance would lead her to leave the church and subsequently focus her research and counseling practice on spiritual abuse.

Matthews, a member of the American Counseling Association, sees many LGBTQ clients in her Garland, Texas, private practice who struggle to reconcile their religious beliefs and experiences with their affectional orientation or gender identity. Many of these clients grew up internalizing a message that it wasn’t just their identity or orientation and behaviors that were wrong, but that there was something “wrong” with them as people, she says.

The LGBTQ community has frequently encountered intolerance from religious institutions. Although there are religious traditions that are affirming and open to LGBTQ people, many are not, says Misty Ginicola, lead editor of the book Affirmative Counseling With LGBTQI+ People, published by ACA. Nonaffirming religious groups usually have markedly rigid beliefs — there is wrong and there is right, and nowhere in between, she says. These are the voices that call for anti-LGBTQ legislation under the guise of exercising their religious freedom. As a result, even LGBTQ individuals who do not identify as religious are affected by nonaffirming religious beliefs, points out Ginicola, a member of ACA.

This conflict has produced not just a broader culture clash, but in some religious traditions, a pernicious history of rejection and outright abuse of LGBTQ individuals. Many of Matthews’ LGBTQ clients have been subjected to a wide range of religiously sponsored or endorsed abusive techniques intended to “cure” them. One client — a gay male — was not allowed to cross his legs or wear pink. He was directed to pray anytime he had “gay” thoughts and to replace “gay behavior” with Scripture reading or increased proselytizing. Other of Matthews’ clients were sent to church-sponsored “reparative” retreats where they were prayed over or even subjected to “exorcisms.” Matthews, an assistant professor of counseling at the University of Louisiana Monroe, has also been told about particularly horrific techniques such as forced ice baths and electroconvulsive therapy.

The emotional and even physical abuse that some LGBTQ individuals from strict religious traditions experience is so traumatic that Matthews says all of the survivors she has encountered in her practice were actively suicidal or had been suicidal in the past. At the same time, because clients from strict religious traditions have internalized the idea that what they are told in their churches is God’s word, it is often difficult for them to label their experience as abuse, she says.

Even LGBTQ individuals who break away from their religious traditions so they can fully embrace their affectional or gender orientation have a hard time discounting what they were taught. If someone who identifies as LGBTQ has been told from a young age that they are inherently wrong and immoral, it creates an inner message that lingers, says Ginicola, an LPC in West Haven, Connecticut, whose practice specialties include LGBTQ issues.

Brady Sullivan, a provisionally licensed professional counselor specializing in LGBTQ issues, has worked with clients who believed God hated them. “Every time they engage in sexual or romantic behavior or participate in pride activities, they feel an overwhelming sense of guilt,” he says.

Examining beliefs

Matthews says that, despite their experiences with spiritual abuse, some of her LGBTQ clients still want to find a way to reconnect with religion or at least retain a sense of personal spirituality. Others no longer want anything to do with religion; they come to counseling to untwine the message of being sinful or wrong from their sense of self and sexuality or gender identity.

The therapeutic relationship that is the core of counseling is especially crucial with clients attempting to navigate a conflict between their religious upbringing or current beliefs and their identity as LGBTQ, Matthews says. When people have been taught to seek comfort and strength from a religious tradition that then ends up rejecting them, it feels like a violation of trust, she says. Unfortunately, that sense of rejection can be further compounded when people in the LGBTQ community seek therapy from a practitioner who turns out to be nonaffirming. Matthews always asks clients if they have previously been in counseling and, if so, what that experience was like. This information helps her to address the therapeutic trauma that some LGBTQ clients have experienced.

Matthews screens for spiritual abuse as part of her intake process. She asks clients about their religious background and beliefs and if their experiences are something they would like to address as part of the counseling process. She says that LGBTQ clients from strict or fundamentalist religious backgrounds are highly likely to have experienced spiritual abuse, so the question usually isn’t “if” they will need to work through their experiences, but “when.”

These clients don’t always disclose or even perceive a history of spiritual abuse. However, counselors can look for a number of red flags, Matthews says. These include clients who:

  • Talk about how they are the cause of their own suffering and need to attend church more and to be more faithful and forgiving to alleviate their suffering.
  • Display magical thinking attached to “good” and “bad” behavior; they commonly believe that accidents, illnesses and other tragedies are the result of their “sinful” behavior.
  • Have a difficult time setting boundaries and saying no because of underlying guilt and shame.
  • Feel powerless to take action or make decisions because they fear repercussions from family members, church members, church leaders or their personal deity.

It is critical that counselors understand their role as helping professionals dedicated to providing a safe and affirming space for all clients, including those who are LGBTQ, says Ginicola, a professor of counseling and school psychology and coordinator of the clinical mental health counseling program at Southern Connecticut State University. Simply sitting with clients, supporting them in their pain and validating their experiences helps the healing process begin, she says.

Once clients are ready to talk about their conflicted views and feelings related to their sexual or gender identity and their experiences with religion, Matthews helps them explore the harmful beliefs they have been holding on to and works to dispel them. She is careful not to disparage clients’ faith traditions but does encourage them to question whether the condemnation they have been confronted with is actually the voice of God.

Lorrie Byrd Slater, a licensed professional counselor-mental health services provider in Chattanooga, Tennessee, who counsels many survivors of spiritual abuse, uses her knowledge of Christianity to help clients examine their beliefs. She urges clients whose religious communities have condemned or disparaged them to consider what the Scriptures say about the nature of Jesus Christ. She then asks them if their experiences are in line with Christ’s teachings. Slater, an ACA member, also reminds clients that their particular church is just one church out of many; other places of worship hold very different — and affirming — views of LGBTQ individuals.

Ginicola says cognitive behavior therapy is particularly helpful when confronting clients’ internalized beliefs that being LGBTQ is wrong or sinful. She asks clients to consider how those beliefs began and who taught them that they are inherently wrong. Ginicola exposes clients to religious viewpoints that are affirming to LGBTQ individuals through documentaries and bibliotherapy or putting them in touch with affirming pastoral help. She also encourages clients to explore a question for themselves: If God is love, as they have been taught by their faith communities, how could he hate them?

Practicing GRACE

Both Ginicola and Sullivan have found the GRACE model originally developed by counselor R. Lewis Bozard and pastor Cody J. Sanders — particularly helpful for guiding LGBTQ clients through the resolution of their conflicted religious views. Sullivan, who is practicing part time in addition to earning his doctorate in counselor education at the University of Missouri–Saint Louis, emphasizes that the model is just a guide, not a step-by-step process. For most clients, he uses only a few of the “stages.” The process involves:

  • Goals: Sullivan, an ACA member, talks to clients about their religious background, asking questions such as what faith tradition they grew up in (Christian, Muslim, Jewish, other) and whether they identify with a particular denomination or sect. He also asks how they feel about what they have experienced, both good and bad.

Ultimately, he wants to find out what clients are hoping to achieve by addressing the conflicts they feel between religious belief and who they are as a person. Sullivan asks: “If you woke up tomorrow and all these issues went away, what would that look like?”

As Sullivan guides clients through their background and goals, he stays alert for reactions, particularly any signs of trauma. If a client seems too upset in a particular session, he will back off and switch to another topic.

  • Renewal of hope: This stage involves uncovering shame and abuse and working through it, Sullivan says. For instance, some nonaffirming religious leaders individually confront LGBTQ congregants with questions about their affectional orientation or gender identity. These confrontations often take on the tone of an interrogation, culminating with  a reminder that “God hates those people.”

Sullivan tells clients that although a particular pastor might think that God hates LGBTQ people, many other religious leaders and faith communities do not hold that belief. If clients are amenable, Sullivan offers to help them make contact with an affirmative pastor to talk about religious views that do not condemn those who are LGBTQ.

  • Action: This stage represents decision time. Sullivan and the client have talked about the religious conflict for a while, and together they’ve processed the client’s trauma and grief. What does the client want to do now?

Sullivan says his role is to explain clients’ options to them and help them identify what they need to do to move forward. Some clients choose to remain planted in their current religious tradition, unready to move on from a community in which their spiritual roots were cultivated, even if that means continuing to wrestle with painful beliefs and practices. Other clients want to stay under the larger umbrella of their current religious faith but choose to find another church home or denomination that is more affirming of LGBTQ people. Still others decide to make a more drastic change, such as converting to a different faith system entirely. And, finally, Sullivan says, many clients decide that they no longer want anything to do with religion at all.

  • Connection: For some clients, processing their past experiences and finding a new place to worship isn’t enough, Sullivan says. Instead, they need to examine their personal relationship with God or whatever higher power they relate to. Ultimately, this involves clients identifying what God or that higher power believes about them and how that affects their view of their religion as a whole.

For instance, Sullivan might probe by asking clients what they believe God’s reaction is when they engage in sexual activity with someone of the same sex. He says that most clients are only able to develop the view that although they are sinning, God loves them anyway.

Sullivan does not like to end the GRACE process with this belief still intact. However, he says the pervasive sense of shame that many LGBTQ clients feel often makes it difficult for them to let go of the notion that living a life that embraces their true affectional or gender identity is sinful behavior. “It’s a struggle to get people to realize that God has made them this way and to accept that they are not sinners,” he says.

  • Empowerment: Sullivan acknowledges that he doesn’t see this stage achieved very often. It takes place only after clients have taken some kind of step such as attending a different church, joining a church-affiliated small group gathering or Bible study, or connecting with a church-sponsored social event, he says. Counselors have an obligation to help clients process these experiences, particularly if they are negative.

“The goal of the empowerment phase is to keep the client traveling down the path toward connection of spiritual and sexual identities, even if they have a negative experience,” Sullivan explains. “This is important because self-confidence and comfort with sexual identity are increased as a result of exploring the intersection between spiritual and sexual identities.”

In reality, Sullivan says, most clients who go through the GRACE model still struggle to reconcile their religion beliefs with being LGBTQ, but they are more at peace with the conflict.

Looking for aff irmative alternatives

One way that counselors can support LGBTQ clients who want to maintain their religious affiliation but feel conflicted is to help them find an affirming congregation, Sullivan says. However, he stresses that counselors must do their due diligence. It isn’t enough to read that the church is part of an affirming denomination or to see that it includes a rainbow flag on its website.

To ensure that he isn’t sending clients into a religious environment that appears affirming but actually isn’t, Sullivan makes a point of calling churches directly. He tells whoever answers the phone that he is a gay man and wants to know the church’s stance on the LGBTQ community. If the person tells him that he is welcome to attend the church and that the church will pray for him and support him in efforts to leave the gay lifestyle, Sullivan thanks them for their honesty but says the church is not for him. Although “welcoming” to LGBTQ people on the surface, churches that hold those types of beliefs do not make it on to Sullivan’s “recommended” list for clients.

Matthews notes that some faith traditions pose a specific and significant challenge to LGBTQ individuals who want to maintain a religious connection. Churches such as the Jehovah’s Witnesses and the Church of Jesus Christ of Latter-day Saints (the Mormon church) embrace particularism — the belief that their particular religious tradition is the only authentic path to God. These paths rest on tenets that are significantly different from what mainstream Christians believe.

For those raised in a church that embraces particularism (and is not affirming of LGBTQ individuals), pursuing their faith by switching denominations is akin to losing their religion entirely, Matthews says. When someone has been told all their life that there is only one path to becoming a Christian and gaining salvation, envisioning another form of faith and worship is almost inconceivable, she explains.

LGBTQ individuals struggling to align their personal and religious identities may look to their families for support. Unfortunately, families are sometimes part of the problem, Matthews says. Many families find it difficult to reconcile their religious beliefs with the reality of their child identifying as LGBTQ.

Matthews has worked with couples from strict religious backgrounds grappling with how to support a child who, according to what the parents hear in church, is living a sinful lifestyle. She provides these parents with psychoeducation by recommending books, giving them information about PFLAG (an advocacy and support organization for the friends, families and allies of those who identify as LGBTQ) and answering their questions, such as whether being LGBTQ is a choice. Matthews might also ask the couple to look for what the Bible actually says about being gay rather than relying solely on what their religious leaders say.

Counselors must also consider that particularly for LGBTQ people of color (POC) or those of low socioeconomic status (SES), leaving their religion behind may also mean losing their community, Ginicola says. “If you are a POC or have low SES, religion is not just a place you go sometimes; it could be a lifeline,” she says.

Losing a whole community can be devastating for anyone, but particularly for someone who has multiple marginalized identities, Ginicola continues. She gives the hypothetical example of a gay black man who, by coming out, loses his church. But when he turns to the LGBTQ community, he may encounter sporadic instances of racism. As a result, he ends up feeling like he is not fully accepted — and, thus, can never feel totally comfortable — anywhere.

Counselors need to let those with marginalized multiple identities know that counseling is one place where they can be fully themselves, Ginicola says. Counseling can encompass all of who these clients are — black, Christian, gay — without judging. Many people seem to think that they can identify either as LGBTQ or religious, but not both, Ginicola notes. She believes the idea that these two identities can’t coexist is harmful because faith — believing in something greater than ourselves, even if it isn’t a deity — is an integral part of life.

Given their negative experiences, some LGBTQ people lose all desire to return to organized religion. Regardless, spirituality can remain a significant part of who they are as people, says Slater, an assistant professor of counseling and associate dean of students at Richmont Graduate University. Spirituality is not the same as religion. In fact, an individual’s spirituality may not even encompass God. Spirituality is simply something that is bigger than us and that provides people with a sense of purpose, Slater says. For some people, that sense of spirituality and meaning can derive from nature, philosophy, personal ideology, science or even the belief in human rights for all, she explains.

Even when LGBTQ clients ultimately decide that they no longer identify with their past religious faith, Matthews tells them that it is possible to hold on to certain positive aspects and values of their religious upbringing that still resonate with them, such as practicing generosity and gratitude and loving others. Or, if these individuals previously enjoyed reading the Bible as literature, she might suggest that they explore other religious or spiritual texts outside of their faith tradition. If the ritual of prayer once provided clients with a sense of peace, she might encourage them to replace that experience with something nonreligious, such as a meditation practice.

Wearing blinders

Counselors who identify as religious know that imposing their values on clients is unethical, and most counseling professionals work hard to bracket their beliefs. Laura Boyd Farmer, an assistant professor of counselor education at Virginia Tech, has published numerous research studies on LGBTQ issues. She recently completed a research study that has not yet been published but that was presented at the 2017 ACA Conference & Expo in San Francisco. The study consisted of a survey that asked 455 mental health and school counselors how they thought their religious beliefs affected their work with LGBTQ clients.

Some respondents said that because their religious traditions were based on acceptance and the idea that Jesus loves everyone, their beliefs had a positive effect, helping them to provide LGBTQ-affirmative counseling. Other participants said their work was in line with their religious tradition, which calls on believers not to judge. Some counselors said that they disagreed with the LGBTQ “lifestyle” but chose not to judge. Others disclosed that their religious beliefs pose a conflict with which they struggle — striving to practice ethically despite their nonacceptance of LGBTQ individuals. Some respondents said that they agreed with the statement “love the sinner, hate the sin” and that this belief did not negatively affect their counseling of LGBTQ clients.

When counselors refuse to counsel LGBTQ clients because their religious beliefs tell them that doing so is wrong, that represents an obvious violation of the ACA Code of Ethics. But where things get tricky is with counselors who take a low-profile nonaffirming stance, says Farmer, an LPC who provides pro bono counseling for LGBTQ individuals in the Roanoke, Virginia, area. These are the counselors who say that they don’t agree with the “lifestyle” but wouldn’t refuse to counsel LGBTQ clients. These practitioners may think that no matter what their beliefs are, they can still maintain unconditional positive regard for their clients, but they might be operating with a big blind spot, Farmer contends.

To illustrate her point, she describes a recent casual conversation she had with a practicing counselor. This person talked about working with gay clients despite believing that being LGBTQ is a sin. The counselor said that they just tried not to judge. Farmer, an ACA member, asked how the practitioner was able to do that. Their response: “To be honest, it doesn’t come up.”

In providing counseling yet not fully accepting LGBTQ clients, this counselor was attempting to manage conflicts with their personal religious beliefs by avoiding pertinent topics. For example, Farmer says the practitioner was working with a gay youth struggling with depression, yet the challenges of identifying as LGBTQ “never came up.” Farmer says this makes her wonder how many other professional counselors are walking around wearing blinders.

Counselors like the one in Farmer’s story are not fully owning — or understanding — their bias, Ginicola says. A bias isn’t just, “I hate these people,” she explains. It’s also that working with someone who is LGBTQ doesn’t feel “right” and the counselor isn’t comfortable with it. By not confronting the discomfort, counselors are much more likely to miss signs (even if unintentionally), miscommunicate and project their worldview on the client rather than identifying the real issues, Ginicola asserts.

Disaffirming counselors resent that ACA’s ethics code requires them not just to set aside their personal beliefs to work with LGBTQ clients but to actually be advocates for them, Ginicola says. These counselors don’t view the experiences of LGBTQ clients as valid, she adds, and it is impossible to work effectively with clients unless you intrinsically embrace their value.

 

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Additional resources

To learn more about the importance of exploring aspects of religion and spirituality in clients’ lives, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Critical Incidents in Integrating Spirituality Into Counseling, edited by Tracey E. Robert and Virginia A. Kelly
  • Integrating Spirituality and Religion Into Counseling: A Guide to Competent Practice, second edition, edited by Craig S. Cashwell and J. Scott Young
  • Understanding People in Context: The Ecological Perspective in Counseling, edited by Ellen P. Cook

Journal of Counseling & Development (counseling.org/publications/counseling-journals)

  • “Psychological Safety and Appreciation of Differences in Counselor Training Programs: Examining Religion, Spirituality and Political Beliefs” by Amanda L. Giordano, Cynthia M. Bevly, Sarah Tucker and Elizabeth A. Prosek
  • “The Ways Paradigm: A Transtheoretical Model for Integrating Spirituality Into Counseling” by Joseph A. Stewart-Sicking, Paul J. Deal and Jesse Fox

Competencies (counseling.org/knowledge-center/competencies)

  • Competencies for Addressing Spiritual and Religious Issues in Counseling

ACA divisions

  • Association for Spiritual, Ethical and Religious Values in Counseling (aservic.org) and Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (algbtic.org)

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Parenting in the 21st century

By Laurie Meyers February 22, 2018

Remember when receipt of a coffee mug emblazoned with “Best Mom Ever” or a T-shirt proclaiming “Best Dad Ever” was enough to validate someone’s skills and aptitude as a parent? In the 21st century, it seems that the ante has been raised. In the eyes of society, parents barely qualify as competent — much less “perfect” — unless they can check off all of the following qualifications:

  • Not only attend to, but anticipate, their child’s every need
  • Orchestrate their child’s academic success
  • Provide their child with all the best experiences and most useful activities
  • Make home an oasis of peace and harmony for the family (while simultaneously prospering in their own careers)

Attendance to one’s children at all times is mandatory. No exceptions will be made for parents working two jobs just to get by, single parents or parents of children with special needs. No foolproof instruction manual will be provided.

These extreme expectations, paired with the rapidly accelerating pace of modern life, present significant obstacles and pressures for parents who genuinely want to make their children feel cared for without driving themselves crazy. Many counselors are routinely helping clients respond to these and other challenges of modern-day parenting.

Parenting, problems and pride

“Always on” parenting requires a lot of problem-solving, which leaves parents focused on all the things that are going wrong, says American Counseling Association member Laura Meyer, a licensed clinical mental health counselor in Bedford, New Hampshire, who specializes in parenting issues and women’s concerns. In particular, working parents often have a difficult time attending every school function that is offered because they typically take place during the workday. This can feel like a failure, particularly for mothers, says Meyer, who is currently researching women’s parenting experiences.

As a kind of antidote, Meyer encourages clients to look for instances when they did something that made them proud of their parenting: “Maybe I wasn’t able to be there for this one particular event, but I made the costume that my kid wore in the play.”

It’s easy for parents to become trapped in the problems that they face, so Meyer encourages a solution-focused approach. For example, she has a client who is struggling with parenting a son who has intermittent explosive disorder. “She was at her wit’s end,” Meyer says. “He was kicking her [and] she was dragging him out of public venues.”

Meyer asked the woman to tell her what went well that week. At first, the client couldn’t think of anything. Then she remembered putting up a Christmas tree with her son. They had enjoyed decorating it together, and the mother took a photo. Meyer asked the client what might happen if every time that she and her son had a good moment together, she took a photo and included it in a chatbook — a social media app that allows users to generate photo books from uploaded pictures. Then they could sit down and look at the photos together each week.

The client burst into tears, saying it would make a huge difference to look at and remember some of the little victories rather than always thinking exclusively about the failures. Meyer suggested that the client could also use the photos to talk with her son about why that particular experience or day had been so good and then ask him how he had been able to remain calm.

Meyer encourages clients to use their counseling sessions as a time to stop and reflect on the quality of their relationship with their child rather than continually reacting to crises. Parents are often susceptible to getting caught up in the everyday duties of being a parent and missing out on the joy, love and upside of parenting, she says.

Helping prevent sexual abuse

Over the course of seven days in January, 156 young women and teenagers gathered in a courtroom in Michigan to recount how Lawrence Nassar, former physician for the USA Gymnastics team and Michigan State University, sexually violated them. Their stories detailed the widespread damage an unchecked predator with access to children and teenagers can wreak. Some of those who came to speak were accompanied by their parents, who were left to ask — in the words of one mother who testified — “How could I have missed the red flags?”

Most parents don’t have much accurate information about sexual predators, says ACA member Jennifer Foster, an assistant professor of counselor education and counseling psychology at Western Michigan University. Her research focuses on child sexual abuse.

In the past, most sexual abuse prevention efforts were aimed at children in the school system, she says. “This helped to create awareness, but the efforts had a major flaw in that they put the burden of stopping abuse on kids,” Foster observes.

As a former licensed mental health counselor and school counselor in Florida, Foster worked with many children who had been abused. “They would say to me, ‘I did say stop. I did say no,’” she recalls. Unfortunately, it is easy for children to be outmaneuvered and overpowered by adults and older children, so prevention efforts should focus on parents and other adults, Foster asserts.

Foster now helps educate parents about sexual predators. “I want parents to know all the scary info,” she says. This includes working to break down conventional myths. When asked to think about the profile of a “typical” predator, most people picture an adult male with a criminal record who is a stranger, or at least not someone the family knows well. Foster tells parents to picture instead the people they might invite to Thanksgiving dinner, because 90 to 96 percent of sexual predators are either family members or someone who is close to the family (the Rape, Abuse & Incest National Network puts this number at 93 percent). According to the Crimes Against Children Research Center, 36 percent are other children.

Parents don’t typically picture a female offender either, and although the reported incidence of sexual abuse by women is low, experts think that the actual rate is higher, Foster says. Unfortunately, parents are much more likely to hand over the care of their children to a woman — in a day care setting, for instance — without really knowing the person’s background, she continues.

Research also indicates a high rate of sibling-on-sibling sexual abuse, often with the use of force, Foster says. Many parents like to assume that this is something that happens only in families with lower socioeconomic status, but the truth is that it can take place in any family. Foster adds that research indicates that if child or juvenile offenders get treatment, they are likely to recover and not go on to commit the same offense again.

Foster teaches parents about some of the behavioral red flags of possible sexual predators, including spending more time with children than with peers, lacking adult friends, having numerous child-friendly hobbies and making inappropriate sexual comments about children. Foster reported a local teacher who regularly made sexually suggestive comments to his female students, such as, “If you were my daughter, I wouldn’t let you out the door in those pants because I know what I would be thinking.”

“That is such a great example of covert abuse, which was allegedly ignored by school staff when girls repeatedly complained about the teacher. That was one of multiple comments he made. They were told, ‘You’re taking it the wrong way. You misheard. You don’t know how to take a compliment.’ Then, when he had an opportunity and a student in isolation, the abuse moved to overt, with him putting his hand up her shirt.”

That student happened to be a member of a youth group Foster helps lead at her church. She believes the girl felt encouraged to disclose to her because of a pen that Foster often uses that says, “Rape. Talk about it.” Another girl in the group asked why Foster had that pen, and that gave Foster an opening to talk about the work she has done with sexual trauma survivors. After the group, the girl who had been violated told Foster about her experience. Foster contacted the school, which she says took no official action, instead simply allowing the teacher to resign.

Parents should also be wary of adults who are always putting their hands on kids or giving kids hugs, Foster says. These behaviors will often take place in front of other people because predators are testing to see if anyone notices and is alarmed by their actions. Predators also try to spend time alone with children and may give them gifts. Foster says that giving gifts can be an entirely benevolent act, but she also warns that it can be a part of the grooming process. Foster’s family has established a rule that her children won’t take gifts from anyone without first asking Foster or their father.

Foster also teaches her children that no secrets should be kept in their family (although she does distinguish between secrets and surprises). Part of the reasoning for this practice is that sexual predators often try to get children to keep small secrets. For example, “Don’t tell your mom I gave you ice cream before dinner. She’ll be mad at me!” Small secrets are a test of sorts, Foster explains. The predator is trying to gauge what a child will and will not tell his or her parents.

Predators are opportunistic — always looking for ways to be “helpful,” Foster says. They often try to come to the rescue, particularly with families in vulnerable situations, such as a family with a chronically ill child, a family that is new to town or a family headed by a single parent, she says. Becoming the family savior is part of the end goal so that they can get time alone with the children, Foster explains.

Although Foster believes that the burden of spotting and stopping child sexual abuse must be placed on adults, she says that it is still important for children to know that it is not OK for someone to touch them inappropriately. Foster likes to teach parents the language that Feather Berkower, a child sexual abuse prevention expert, uses about “body safety.” The concept is simple enough that even little children can learn it.

Body safety means that no one can look at, touch or take pictures of the child’s private parts, and children should not look at or touch another person’s body parts, Foster explains. She believes that children who aren’t taught about body safety are more vulnerable because they don’t have the language to talk about something that has made them feel uncomfortable, including actual abuse. Children should also learn the anatomically correct names for body parts, Foster says.

Foster’s son knows that everyone has to follow body safety rules. If he goes to a friend’s house, Foster also makes sure that the friend’s parents are aware that Foster’s family follows body safety rules. In addition, because of the prevalence of child-on-child sexual abuse, Foster does not allow closed doors when friends come over to play at her family’s house. She also intermittently checks in with her son about his interactions with the adults in his life by asking if he had fun with the person, what they did together and whether the person followed the body safety rules.

Most parents are also in the dark about how to keep their children safe online, Foster says, but they need to be aware that sexual predators often use online means to target children. Perpetrators often develop social media accounts and profiles, posing as someone who is the same age as the child or adolescent they are targeting and then revealing their true age later. After earning the young person’s trust, the predator may attempt to entice the child or adolescent to meet in person and move their encounters offline.

Foster recommends that families confine technology use to open spaces such as the TV room or kitchen. Parents can make use of tracking tools, but they should also have an open dialogue with their children about their online activity, Foster says. She also advises that parents find out what kind of technology rules other parents have before allowing children to go to their friends’ houses.

As a whole, Foster says, a higher level of vigilance against sexual abuse is required. She notes that most parents are good about discussing safety with their children when it comes to looking both ways before crossing the street, using a helmet when riding a bike or always wearing a seatbelt in the car. But more children are sexually abused each year than are hit by cars, and relatively few families take active steps to prevent that from happening.

“When it comes to child sexual abuse, adults need to take on the responsibility to create safe homes and communities,” Foster says. “Counselors [can] give them the tools they need.”

No longer partners but still parents

“Divorce changes kids’ lives [and] usually not in good ways,” says Kristin Little, a licensed mental health counselor whose Seattle-area practice includes a focus on counseling families that are navigating divorce or separation. “However, kids can manage even difficult divorce changes if well-supported and protected from the most harmful effects of conflict [such as] loss of confidence in their parents’ ability to lead, loss of stability in home/school life and loss of relationship with either or both parents.”

Little says the most essential thing that mental health professionals can do when counseling parents who are separated, divorced or in the process of divorcing is to introduce the idea of the separation of “adult mind” and “parent mind.”

“Parents can be experiencing a high level of anger or sadness while their marriage is ending. This is normal and expected and may be important for them to explore individually,” she says. “However, they continue to be parents and need to separate their own adult experience and reactions from their parenting roles. Giving parents the permission to feel, yet reminding them that they have the responsibility to attend to parenting needs, make important decisions, [and] see and respond to their children’s needs and feelings as separate from their own, is vitally important.”

ACA member Kimberly Mason, a licensed professional counselor (LPC) in Madisonville, Louisiana, who specializes in family and relationship issues, says that many parents have difficulty managing their anger, guilt and shame, and setting aside their conflict while parenting. To better shield their children from strife, she gives the following recommendations to parents:

1) Have ground rules for communication. Parents should not berate each other or argue in front of their children. If necessary, they should go to a private area to work out their conflict.

2) Each parent should seek individual counseling to work through his or her own issues. This can help limit the level of animosity and frequency of arguments that may occur in the home.

3) Model mutual respect for each other in front of the children. Each partner should also talk to family members and friends and ask them to refrain from saying negative things about the other partner in front of the children.

Parents who are facing divorce or separation are often terrified, which can override their ability to collaborate and make decisions, Little says. They may seek safety by sticking to past patterns of interacting and relying on assumptions about roles or capabilities that they held during the marriage or relationship, she explains. They often have difficulty envisioning change.

“This can result in one parent insisting that they are more experienced than the other and thus deserving of more time, which inevitably triggers fear and anger in the other parent and results in what we often see as a tug of war that rarely serves the kids’ or parents’ needs,” Little says.

Counselors can be a neutral “referee” of sorts for parents, steering the conversation away from who is wrong or right and instead toward developing a working co-parenting relationship that focuses on the future, she says.

ACA member Monika Logan, an LPC in Frisco, Texas, has a practice that focuses on divorce and parenting issues. She says that parents need to learn to form a more businesslike relationship by setting aside their emotions toward each other. Parents can begin to do this by “working on their own feelings related to the separation or divorce and developing a support network,” she says.

Little agrees with encouraging that approach. “[It] allows them to get the important job of parenting done,” she says. “It is essentially undoing the patterns, dynamics and practices of the marriage to allow for a renegotiation of how they will interact [and] the tasks they will agree to in the new co-parenting relationship.”

Each partner must agree to the new “business” guidelines or they won’t work, says Mason, who is also a core faculty member at Walden University. They must commit to putting their children’s needs above their own and making joint decisions. Compromise and consistency are also essential. The parents must be willing to back each other up when making decisions so that the children will still view them as a team, she emphasizes.

“Contrary to what some people describe, healthy co-parenting can be anywhere along the spectrum from parallel parenting — having little contact and overlap between homes and parents — to how co-parenting is usually thought of — frequent collaboration and interaction,” Little says.

There is no one-size-fits-all approach to co-parenting, she says. A counselor’s job is to help parents craft a plan that works for each partner, minimizes conflict and, most important, meets the needs of their children.

Coming to terms with coming out

As the LGBTQ (lesbian, gay, bisexual, transgender and questioning or queer) community has gained greater acceptance during the past 10 to 20 years, it has become more common for young people to come out to their parents, says ACA member Misty Ginicola, an LPC in West Haven, Connecticut, whose practice specialties include LGBTQ issues. She adds that those who come out are also often taking that step at younger ages than in the past — for instance, as middle schoolers rather than as teenagers.

How parents react to that decision is incredibly important to the mental health of the child. Ginicola, the lead editor of the ACA-published book Affirmative Counseling With LGBTQI+ People, has witnessed parent reactions in her practice that ran the gamut from accepting yet concerned to completely opposed and voicing a desire to “fix” their child. She tells parents looking to “cure” a child that counselors cannot, either from an ethical or a practical standpoint, change someone’s sexual/affectional orientation. However, Ginicola does try to address the concerns of all parents who come to her for help, whether they are “affirming” parents (who are supportive of their child’s orientation) or “disaffirming” (those who reject LGBTQ status).

Even parents who are supportive of the LGBTQ community may have problems adjusting to their own child coming out, she says. They may ask if the child is “sure” or, if a child comes out as gay or lesbian and then subsequently shows interest in someone who is other gendered, they may say, “Oh, so you’re really not [gay or lesbian],” Ginicola reports. These kinds of reactions often spring from parents’ fears that their child will be bullied or belittled or face other hurtful consequences, she says.

However, Ginicola explains to parents that when they ask those kinds of questions or make those kinds of statements, what their children actually hear is that something is wrong with them. Children are very vulnerable when coming out. In fact, the risk of suicide is highest during the coming-out process, but research shows that having supportive parents reduces this risk by half. So, it is crucial for parents to strive to always communicate support and to be willing to admit and apologize when they have said the wrong thing, Ginicola emphasizes.

Ginicola also teaches parents that although they cannot keep their children from being bullied, they can help them cope by building and reinforcing their self-esteem, teaching them good social and emotional skills, and ensuring that they have allies such as friends, teachers and school counselors in place.

One of the ways parents can help build their children’s self-esteem is by helping them find places where they will be accepted through whatever interests and activities they enjoy, Ginicola says. She cautions, however, that parents must take it upon themselves to ensure that these places are safe and not an environment in which their child will be rejected or targeted.

Parents should also talk to their child’s school to confirm that it has sound anti-bullying policies in place, Ginicola says. Most important, parents must make sure their children understand that there is nothing wrong with them and that they are not the problem, she emphasizes.

Unfortunately, the reality is that although acceptance for those who identify as LGBTQ has grown tremendously, they are still at increased risk for experiencing violence, meaning that parents need to talk to children who have come out about safety, Ginicola says. Specifically, children should be careful about who their friends are and make sure that they attend parties and other social events with people who are affirming, she says. Parents should also caution children who are not fully out to be very careful about whom they tell, not because there is anything wrong about telling but because sometimes it can be unsafe, Ginicola says.

Open communication is also essential. Children need to know and trust that they can tell their parents anything, Ginicola says. It is particularly critical that children understand the necessity of informing their parents about any instances of bullying, violence or other actions that threaten a child’s safety, she says.

Counselors must also prepare parents for the rejection that they will experience, Ginicola points out. For example, it is possible that family members might say hurtful things about a child who has come out and question how the parents are raising the child, she says. Community members may also weigh in with their own judgments, which Ginicola has experienced personally, including when a neighbor called child protective services because Ginicola lets her nongender-conforming son wear pink shoes to school. Nothing came of the neighbor’s call, but “it’s scary to realize that while I am getting the rejection for him now, someday he will receive that,” she says.

In some cases, parents may lose a whole community in which they previously felt secure and safe, Ginicola says. For example, in the African-American community, the church often serves as the main safe space for its congregants, but many churches are not affirming of LGBTQ individuals. By choosing to support their children who identify as LGBTQ, the parents may lose an essential source of support.

In cases such as these, Ginicola helps her clients process their grief and encourages them to seek alternative sources of support, such as other parents who have gone through similar experiences. She is also able to recommend online and local groups to which parents can turn. Ginicola also provides validation for the parents, emphasizing that it is the culture that is the problem, not the parents themselves. Another part of the service that counselors can provide these clients is to make sure they are practicing good self-care, she adds.

Ginicola also sees parents who are totally unsupportive of their child’s LGBTQ status. She acknowledges walking a fine line with these clients. Although she doesn’t want to support their beliefs, she tries to identify a way to reach them so that they don’t instead go find a therapist who is willing to attempt to “change” their child.

“[It requires] the same principles that underlie work with any parent that is potentially destructive to a child,” Ginicola says. “[It’s] a delicate balance of keeping them feeling validated without promoting harming their child.”

She starts by probing for what is at the root of the parents’ nonaffirming stance. “Let’s say it’s religious beliefs. You [as the counselor] can’t start quoting Bible verses,” Ginicola says. “That’s not our place, and they’re not going to listen to us anyway because we’re not within their religious group.”

Ginicola validates parents by saying she can see that it might be difficult to feel caught between two conflicting forces — the instinct to love and support their child versus their belief in a religious tradition that rejects their child. Rather than attempting to challenge their religious beliefs, she looks for inconsistencies and discrepancies that she can point out.

“I might say, ‘I’m hearing you say that in your faith you are supposed to love and support your child but also hearing that this [coming out] is something you can’t support. How do you feel about that conflict?’”

Ginicola tries to get these clients to a point at which they are willing to join local or online support groups and talk to other parents who have gone through the same experience. She reasons that these parents will be the best source of support and advice on coping with the conflict of belonging to a faith tradition that does not affirm LGBTQ identity and culture, yet wanting to support a child who is LGBTQ.

Sometimes parents are unwilling to let go of whatever beliefs are informing their anti-LGBTQ stance. In these situations, Ginicola lets them know that they are choosing a dangerous path. When families utterly reject children who come out as LGBTQ, the risk of suicide is exponentially increased.

“At some point,” Ginicola observes, “they have to ask themselves, do they want a gay son or a dead son?”

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Stepping In, Stepping Out: Creating Stepfamily Rhythm by Joshua M. Gold
  • Casebook for Counseling Lesbian, Gay, Bisexual, and Transgender Persons and Their Families edited by Sari H. Dworkin and Mark Pope
  • Youth at Risk, sixth edition, edited by David Capuzzi and Douglas R. Gross

Practice briefs (counseling.org/knowledge-center/practice-briefs)

  • “Divorce and Children” by Elizabeth A. Mellin and Lindsey M. Nichols
  • “Parenting Education” by Carl J. Sheperis and Belinda Lopez

ACA divisions

  • Association for Child and Adolescent Counseling (acachild.org)
  • International Association of Marriage and Family Counselors (iamfconline.org)

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Ethics, religion and diversity

By Gregory K. Moffatt February 5, 2018

Tears streamed down her face. Kaylah (not her real name) was a 21-year-old woman struggling with a romance in trouble. I’d seen it many times, even though I’d only been in the field for a few years at this point. My heart broke for Kaylah as I saw the same old story played out in the same old way — only the names and a few of the details were new.

Kaylah had been psychologically mistreated and her relationship was in serious trouble. Her partner demonstrated what social psychologists call the principle of least interest. This principle teaches that the person in any relationship — work, friendship, marriage — who has the least interest in maintaining it possesses the most power. My client’s partner treated her well on occasion but at other times humiliated her in front of others, exploded at her or ignored her for days on end. Kaylah tolerated these behaviors because she was desperate to maintain the relationship.

Kaylah’s partner’s emotions ran hot and cold. One day, they were talking about starting a family; the next, Kaylah’s partner threatened to leave, causing Kaylah to feel confused, hurt, angry and torn. Like most abused women, at times Kaylah felt surges of confidence that she should leave the relationship and never look back. Then, as if someone had flipped a switch, she was overwhelmed with love, hope and compassion for her relationship. In this phase, Kaylah made excuses for the pitiful way she was treated and assumed all the responsibility for their relationship troubles. It was classic battered woman syndrome.

What readers also need to know about Kaylah is that she was a lesbian. She was also a staff member at a church. Her lover, a member of the pastoral staff, was also Kaylah’s boss, which created a serious power issue (and a significant ethical issue too). For obvious reasons, the relationship was a carefully guarded secret. Kaylah had no one to talk to because her family wasn’t receptive to her lesbian lifestyle and she didn’t feel she could confide in her friends in the religious community. She also worried that if anyone found out, her partner would terminate the relationship — the thing Kaylah feared most in the world. Exposure might also mean that Kaylah could lose her job, her family and the few friends she had. She was totally isolated. What a mess.

One last thing that I need to tell readers: I am a person of religious faith, and until I met Kaylah, I hadn’t been forced to clarify the place for my religious beliefs in the counseling profession. That day, the decision I faced became crystal clear to me.

No room for debate

It was around the time that Kaylah entered my world that I taught my first college course overseas. As I was preparing to teach a marriage and family course in India, it dawned on me that our two cultures were very different. I worried that my knowledge would be so based in American culture that it wouldn’t translate well into Indian culture. But without denying our vast differences, my host reassured me. “Dr. Moffatt,” he said, “problems are problems.”

How right he was. Hurting relationships are the same regardless of culture, age, religion or sexual orientation.

In some ways, I can’t believe that equity for LGBTQ clients even remains a topic for debate. I remember when the AIDS epidemic first became public in the 1980s. Some people of religious faith actually stated that AIDS victims deserved the outcome as punishment for their lifestyle. I hope that even the most cold-hearted person today wouldn’t utter such nonsense. Even in those uncertain times when we didn’t know much about the disease, doctors served these men and women because it was their professional duty to do so, regardless of their personal opinions on homosexuality, drug use, multiple partners or other factors. Today, many nonprofit counseling agencies are run by faith-based agencies specifically for those who have HIV/AIDS. Thank goodness.

How, then, could there still be any possibility of debate in the 21st century over whether we should discriminate against our clients? Our concept of human rights as counselors is that all people deserve the same treatment, regardless of worldview, religion, gender, age or creed. Our modern view of equality has been evolving for decades, yet even counselors have not yet perfected it in practice. Just in the past decade or less, there have been several highly publicized court cases in which graduate students have refused to work with gay clients and suffered academic consequences because of their beliefs. These include Julea Ward in 2009 at Eastern Michigan University, Jennifer Keeton in 2010 at Augusta State University and Andrew Cash in 2014 at Missouri State University.

Supporters of these students lauded their bravery and commitment to their religion. Even though I am a person of faith, I cannot see why this type of irresponsibility to clients should be lauded. Interestingly, Christian tradition teaches that Jesus spent most of his time with the outcasts of his culture, not with the religious upper echelon, and he didn’t abandon people simply because they behaved in ways that were contrary to Jewish teachings. Gandhi and Mother Teresa also demonstrated a seeming lack of interest in religious pedigree. Instead, they helped the people who came to them.

Sadly, the three lawsuits from academia that I noted are just the ones that made the news. I suspect that many more therapists are practicing discrimination without the public becoming aware. “I’m not culturally competent to work with those issues” is a common argument that I hear among some in the profession to justify their referral of LGBTQ clients. In fact, the real reason is often a personal belief system rather than a question of competence. There is no way to tell how much of this type of referral or redirecting of client goals happens in our profession, but if my anecdotal experiences as a clinician, supervisor, professor and public figure in the field are any measure, the answer is a lot.

This clearly violates our ACA Code of Ethics. Under Standard A.4.b., we are clearly called to “seek training in areas in which [we] are at risk of imposing [our] values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.” Notice that it says seek training, not refer. In fact, Standard A.11.b. specifically prohibits referring solely on the basis of a conflict between the counselor’s values and the client’s values.

This culture war hit home for the American Counseling Association in 2016 when the Tennessee Legislature passed a bill that the state’s governor subsequently signed into law making it legal for counselors and therapists to discriminate against their clients if the client’s “goals, outcomes or behaviors … conflict with the sincerely held principles of the counselor or therapist.” This legislation clearly contradicted the ACA Code of Ethics. Consequently, ACA moved its planned 2017 annual conference from Nashville to San Francisco.

It should be noted that before we even get to the standards in the ACA Code of Ethics, our association’s mission statement directs that we exist to “promote respect for human dignity and diversity” through the profession. The key word here is not diversity but rather promote. We are actively to promote diversity, not actively run away from it.

A common base for truth

For any reader who thinks that I am not sensitive to the importance of religion, please bear with me. Religion does indeed matter, and many religions have clear teachings on a variety of subjects — sex, marriage, work, the roles of men and women — that are central to people’s faith and shouldn’t be ignored. But we must also recognize that many discriminatory traditions have their roots in religious teachings. Even in my short lifetime, I can remember a relative of mine excusing the discriminatory practices of his all-white church, saying, “God didn’t intend for the races to mix.” He then proceeded to use Bible verses to justify that belief. He made similar comments about mixed-race marriage, again justifying them weakly through religious teachings. Refusing to see clients based simply on sexual orientation is no different.

Some religious therapists have defended discriminatory practice by arguing that equating racism with clinical treatment of gay couples is comparing apples and oranges. The argument goes that if a counselor’s religious views teach that, for example, the heart of a couple’s problems is directly related to homosexuality — something the counselor’s religion teaches is inappropriate — then helping these clients maintain the very relationship that is causing their grief would be problematic if not unethical/immoral. I’ll address this argument momentarily. But, first, a brief tangent.

It would be disingenuous to say that counselors never force a worldview on a client. Of course we do. For example, one of the goals we almost always have for clients who are addicted is that they stop doing their drug of choice, even if they don’t want to stop. The difference between this worldview and that of the anti-gay worldview, however, is that this worldview is based on objective research, not moral code or religious teaching. Using methamphetamine destroys tooth enamel, leads to degenerative behaviors and can eventually kill the user. Alcohol abuse changes brain structure, destroys the liver and leads to degenerative lifestyle and potentially death, not to mention a host of other social ills.

As for a religious argument against homosexuality, there is no scientific evidence that being gay, transsexual, bisexual, etc., is clearly linked to any social or physical issue that is not also present among the heterosexual population. We must have a common base for “truth,” and that base is research, not religion.

Many years ago, a religious group, knowing I am a person of faith, asked me to do a seminar addressing why homosexuals would not be good parents. I refused because there is absolutely no evidence that one’s sexual orientation has anything to do with quality of parenting. It would be unethical to promote such a baseless argument. Academic integrity demands that as professional counselors, we pursue what we know. We must be driven by facts, not opinions and preferences.

Make a choice

Empathizing and working with a diverse population does not mean that a counselor must sacrifice her or his own position. We are free to think what we want, engage in our own religious practices and beliefs, and live our lives as we choose.

For many years, I’ve spent part of my year in the United States and part of the year in Chile, my second home. During this time, I have also traveled the world. Whether I’m in a clinic in India, the Philippines, Peru or Mexico, I still think like an American/Chilean. But when I’m in those varied cultures, I try to see the world through the eyes and culture of the people I encounter. I can easily do that without making any value statement about the culture itself, and even though I have personally adopted many customs and preferences from around the world, I have done so voluntarily. I would still be a competent counselor in those cultures if I hadn’t. My preferences are irrelevant when working in another country.

Our professional ethic simply means that we will not thrust our belief systems upon our clients any more than we would try to sell our clients a car, recruit them into a political party or manage their retirement accounts. What we cannot do is make choices that are at odds with wanting to work as a counselor, such as simultaneously wanting to function as a missionary who proselytizes clients into our personal belief system.

I occasionally work with individuals who have been mandated to treatment. Some of them have drug issues. I’ve heard all the arguments:

“Why is weed illegal? It’s a dumb law.”

“Who cares what I do in my own home?”

“Smoking weed doesn’t affect my job or my personal life, so why should I have to go to addiction counseling?”

My response is always the same. You can do anything you want — but all behaviors have consequences. If you want to smoke weed, go ahead. But if you don’t want to risk arrest, being fired from your job or kicked off your athletic team, don’t smoke weed. You can’t have it both ways.

To our profession, I make the same suggestion. If you are a pastor or priest, be a pastor or priest. Nobody is trying to stop you. But do not attempt to be a pastor while you are a counselor. If your religion teaches that you must proselytize in the workplace, then the counseling profession is not the best fit for you. There is nothing wrong with being a pastoral counselor in which your focus is pastoring, not counseling. But don’t pretend to be a counselor who is religious when, in fact, you want to function as a pastor who is also a counselor.

As counselors, our job is to help the hurting. We cannot — we must not — attempt to evaluate who we think is worthy of our help. Whether our clients are gay or lesbian, battered women or batterers, abused children or abusers, we don’t pick and choose who we help. Our ethical standards determine when we refer or step away, but our personal feelings — whether driven by religion, morals or anything else — have no role in our decision to help. Pain is pain. The pain of Kaylah’s relationship was no different than the pain from any other relationship. The fact that she was a lesbian was, in some ways, irrelevant.

Diversity includes people of faith

History hasn’t always been friendly toward people of faith. We hardly need to be reminded of the many wars and episodes of genocide that have been perpetrated against various religious groups throughout history. Even today in different places around the world, including the U.S., Christians, Jews, Muslims and others are persecuted for their faith. Television mogul Ted Turner brashly claimed in 1990 that Christianity was a “religion for losers.” These were thoughtless words from one who knew nothing of the religion. Jewish men, women and children are still isolated in many parts of the world. And I can’t imagine how difficult it must be to live as a Muslim in the U.S. Sadly, the words “Muslim” and “terrorist” are sometimes used interchangeably these days.

The field of psychology has not always been friendly to people of faith either. Sigmund Freud proposed that neurosis and religion were closely related and that religious people were weak and in need of a dominant father figure. In the 1950s, Alfred Kinsey despised religion, claiming it repressed “healthy sexual desires.” And as a graduate student, I was taught that we should never talk about religion in session, even if our clients brought it up, because it would only distract from more important issues. Really? Faith can be a central part of a person’s existence, influencing almost everything, from food, dress and marriage to job choice and child rearing. Yet I was taught that this was somehow unimportant and distracting.

About 20 years ago, I was presenting an ethics seminar for professional counselors. One of the case studies the seminar participants were supposed to discuss involved religion. The concise version of the question I posed was, “If your client was a person of religious faith, would it be acceptable to include that person’s religion in your therapeutic process?” Every single one of the 75 or so participants said no. Apparently, they had the same training I had.

I have personally witnessed bias within the counseling profession against people of faith. At professional conferences, I have heard comments in hallways and elevators openly disrespecting people of various religions. One clinician, wearing her conference name badge, rolled her eyes as the elevator door closed and said to another attendee, “Oh, God, this hotel is crawling with Christians. Heaven help us!” To which her friend snickered and nodded consent, as if Christians, Jews or Muslims were some sort of infestation.

At a past ACA annual conference, I attended a workshop on gay and lesbian issues. In the workshop, the leader subtly condescended to people of faith — something Derald Wing Sue calls microaggressions — and the audience openly jeered, laughed and mocked Christians in their public comments. No one said a word about the overtly biased, thoughtless and hurtful commentary. Although I certainly didn’t fear for my safety, I didn’t feel comfortable confronting this bigotry. And even though I agreed with the position presented by the session leader, I have never felt more discriminated against in my life.

The heckling I witnessed was the same thing that those in the LGBTQ community have rightly fought against in times past. It was the same behavior — only the target had changed. People of faith should be as welcome as members of any other group in a professional meeting.

I might also argue that people of religious faith can make outstanding counselors. Many religions teach the inherent value of all humans, creating a natural empathy among the religious for a hurting world. Although there are individuals who have used religion to pursue their own selfish agendas, there is no scientific evidence that people of faith are less intelligent, weaker or any less capable of working in the helping professions than are nonreligious individuals.

Conclusion

In a public presentation many years ago, Albert Ellis, a man known widely for his aggressive approach to his clients, littered his address with profanity. Visibly upset, several participants in the room eventually made an overtly public statement by storming out. The only remark Ellis made about it was this: “Counselors should never be upset with what people say.”

I have never forgotten those words. Whether or not Ellis was right, the message I took away was that, as counselors, we treat those who need help. In that regard, our clients’ words, sexual orientation, religion, age, gender, race, criminal history and socioeconomic status have no relevance. We help. That is what we do.

Many people in the counseling profession are also, in their personal lives, deeply committed to their faith. These counselors see clients daily without issue and function at the highest level of ethical conduct. But the few who feel they are called to change the profession, rather than to accept the profession as it is or to move on to another line of work, give us a black eye. Even worse, these counselors leave clients hurting — and perhaps discourage them from ever seeking help from another counselor again. It is always about the client.

Counselors using their religion as an excuse to refer clients or to force their ideas about sexuality upon their clients can deceive themselves into thinking they have ethical grounds for doing so. You don’t. Period. You must seek training to work through this issue (Standard A.4.b.) rather than perpetually referring LBGTQ clients.

As a footnote, I saw Kaylah in counseling off and on for a little over a year. During that time, her relationship went through various ups and downs. When we terminated, her daily functioning had improved significantly, but she was still nursing her seriously troubled relationship.

Months after termination, I happened across Kaylah in a shopping center. She was with her mother. Meeting clients on the street always makes me nervous, but when our eyes met from a distance, she beamed and ran toward me, towing her mother along by the hand.

Kaylah introduced me to her mother and, in turn, her mother’s face brightened. She stepped forward and hugged me tightly. When she stepped away, she had tears in her eyes. “I don’t know what all you did, but I know you saved my daughter,” she said. “Thank you for helping my baby.”

These were the most sincere and heartfelt words of gratitude I have ever received. I’m positive I did the right thing by my client, and I can’t imagine a world in which my religion would have allowed me to tell Kaylah to move along because I don’t work with clients who are gay.

 

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Gregory K. Moffatt is a professor of counseling and human services at Point University in Georgia. He is a licensed professional counselor and certified professional counselor supervisor. Contact him at Greg.Moffatt@point.edu.

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Other pieces written by Gregory K. Moffatt, from the Counseling Today archives:

 

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