Tag Archives: LGBTQ Issues

LGBTQ Issues

Helping LGBTQ+ individuals — One story at a time

By Luke Romesberg August 12, 2022

“I came across your article. I’m in a desperate situation. I need help. I wasn’t sure who else to turn to.”

No matter how many times I receive email messages such as this, it is always somewhat of a surprise for me. My previous Counseling Today online exclusive “Conversion therapy: Learning to love myself againhas led me to receive a consistent array of messages from folks of all ages and geographical locations who are struggling with their sexual orientation and gender identity.

Some of the emails contain positive messages: folks who commend me on my bravery to tell my coming-out story. Many of those same people are also shocked I was able to navigate the situation in a manner that led to me having what most would consider a successful personal and professional life. However, the majority of emails I receive are from folks who are in dire need of support and are living in situations and communities where they do not have support or are unable to find support that is confidential. Without appropriate resources, many of these people are at their wits end. The struggles include being trapped at home with unsupportive, homophobic and transphobic family members; being stuck in a marriage in which one’s partner has no idea the other partner is hiding their sexual orientation; being bullied in school; or living one’s entire life with unaddressed trauma stemming from being forced to repress one’s sexual identity. (Please note that the stories and emails I share in this article have been altered to protect the privacy and confidentiality of those who have reached out. All identities remain 100% confidential.)

Conversion therapy throughout the world

First, let’s explore the current state of conversion therapy. Several places have bans against this practice. According to a Stonewall.org article on conversion therapy bans, Brazil led the charge by introducing a ban on conversion therapy in 1999. This ban on therapy relating to sexual orientation was considered groundbreaking at the time, and it helped to set the standard for other countries to follow. In 2000, Norway issued a similar ban, and Samoa banned “registered health professionals from practicing conversion therapy” in 2007. These types of bans continued in places across the world, including in Argentina and Fiji in 2010, Ecuador in 2014, Malta in 2016, and Uruguay in 2017. In 2021, Chile introduced a medical ban and India issued “directives to prohibit conversion therapy.” This year, France and New Zealand also passed laws banning the practice.

Canada initially started banning conversion therapy practices in various provinces and territories, including Ontario, Nova Scotia, Prince Edward Island, Quebec and Yukon, and in December 2021, it banned conversation therapy entirely. The United States has had taken a similar approach. According to the Movement Advancement Project, California was the first state to pass a ban on conversion therapy in 2012, followed by New Jersey in 2013; District of Columbia in 2014; Oregon and Illinois in 2015; Vermont in 2016; Connecticut, Nevada, New Mexico and Rhode Island in 2017; Delaware, Hawaii, Maryland, New Hampshire and Washington in 2018; Maine, Massachusetts, New York, Colorado, and Puerto Rico in 2019; Utah and Virginia in 2020; and Minnesota in 2021. In addition, Michigan, Minnesota, North Carolina and Wisconsin have all partially banned the practice and signed an executive order prohibiting the use of state funding for conversion therapy for minors. And roughly 100 other U.S. counties, municipalities and communities have also issued ordinances banning conversion therapy practices. Please note that some states and districts may only have partial bans, meaning some aspects of conversion therapy may still be legal or eligible for state funding.

The good, the bad and the ugly

Although as a society we have made progress toward the expulsion of conversion therapy, we still have a long way to go, which is evident by the range of emails and stories I received after writing my online exclusive in 2017. And it is important that we do not forget those who may have been left behind or who have not had the opportunity to benefit from the successes of dismantling conversion. We must continue to recognize everyone’s unique experience in dealing with conversion therapy and other methods of identity repression. The following two stories represent a very small margin of the emails I have received from folks reaching out for guidance.

Feeling alone, scared and unsupported  

I received an email from a young person who described themselves as trans-identified and stated they had recently come out to their parents. They were met with pushback and were encountering consistent transphobic and homophobic verbal abuse. They mentioned many of the issues I had previously written about in my CT online article such as feeling as if they had no outlet to be themself. They expressed fear for their future and wondered if they would even have a future. They said that when they purchased clothing that aligned outside of their assigned sex, their parents would find the clothing and throw it in the trash. They were literally and figuratively being stripped of their transhood.

When receiving a message such as this, it is nearly impossible to not immediately feel a sense of darkness and heartbreak — not simply for this individual but also in a grander sense. Homophobia and transphobia are issues that are plaguing queer youth, and they are not issues that simply end as one gets older. Eventually the negative messages they are constantly being fed consume their thoughts, and in turn, it begins to affect their mental health, physical health and any healthy sense of self-identity they may have one once held. The lack of familial support and downright abuse day after day after day will eventually break someone down, and this theme will often continue into one’s adulthood.

After reading this email, I knew this young person was in dire need of any support and genuine kindness, and they were purposefully being kept in an environment that didn’t provide or allow for that. It is important to note that the idea of being able to provide virtual support to a minor, who needs to keep everything a secret from their family, is incredibly challenging. It can also be dangerous for the younger person as they attempt to secretly navigate the situation. This youth put themselves at risk with every email correspondence with me. They were guarded in their emails and left out descriptors such as their specific age and geographic location, which made locating exact resources impossible. However, given the description of their small town, it seemed as though these potential resources likely did not exist.

I drew from my own experience and thought of the outlets I had used when I was under the age of 18 and dealing with conversion therapy in a small town without many LGBTQIA+ resources. I turned to my honors English teacher; she was the first adult I came out to aside from my parents. At the time, I was still living in an environment where I had to be secretive about my sexual orientation. Even after coming out, I was forced to maintain the façade of being heterosexual. My teacher was one of few adults I could trust, and I genuinely enjoyed taking her class. One of our assignments involved creating a CD of songs, along with a description of each song and an explanation of how the songs applied to our life. I used this assignment as my coming out story to her. This project resulted in my teacher giving me 100 bonus points (which meant I was guaranteed an A+ in her course), but more importantly, it also gave me confidence and the knowledge that coming out would not necessarily always be met with a negative response. Even in a very conservative area with seemingly no LGBTQIA+ supports, there were still folks out there who held compassion, understanding and positive regard for those whose identity falls under the queer umbrella.

I shared this story with the youth who was emailing me. We explored potential adults at school they felt they could trust. We also discussed the possibility that someone they thought would be supportive may not be. It is impossible to predict how somebody will react even if you feel you know them very well. And as queer people, we truly do not know how somebody will handle our queerness. Sometimes the benefits of coming out outweigh the risks, but sometimes they do not.

Understanding this risk, the young person decided to reveal their identity to a trusted teacher. Luckily, their music teacher was supportive and has managed to be a consistent outlet for them to express themselves and receive kindness and support in return. Obviously, this does not fix this youth’s entire situation as they are still under oppressive and transphobic control by their parents, but it does help to lighten this hardship. My English teacher was a major saving grace for me. Without her support, I fear that I would not be typing this today. I can only hope that the youth’s music teacher is as strong of a support system as my English teacher was for me.

Although my advice for this youth may seem simple or generic, it is important to remember that even in what seems to be the darkest hour, one can still find a light, no matter how big or small. Even in an area where LGBTQIA+ resources may be nonexistent or inaccessible, there are still folks out there who possess compassion and a willingness to go above and beyond to support someone who is in need. Sometimes we must go through the incredibly difficult process of attempting to trust another person with a secret — one we have already faced so much backlash for revealing. Being met with negativity when coming out just makes the process of coming out to someone else even more difficult. The story illustrates a common theme I have seen in the majority of emails I have received: folks who feel alone and unsupported.

The struggle of coming out

I also have gotten emails from people who haven’t come out yet. I received one at 3:04 a.m. I don’t often sleep much, so I was wide awake, and I read it immediately. The email was full of desperation. The man described himself as Muslim and said that he was attracted to men. He claimed his wife had no idea and they had been married for over three decades. He said that he was on verge of losing his marriage and children, and he was desperate to make things work with his wife. He had stumbled across my CT Online article and was able to relate to it because he remembered feeling stifled as a child. However, unlike me, he had never come out to anybody. He noted that this email was the first time he had expressed his feelings.

He described himself as a “frilly” child, which I interpreted as feminine. This had caused him to be bullied at school and at home, especially by his brothers, and it led to others making assumptions about him. He didn’t include many overt details regarding his school experience aside from stating that he did not have many friends — just one other boy with whom he had sexual relations when he was about 13-15. At one point, his brother walked in on them and discovered this sexual relationship, which resulted in him being physically beaten by not only the brother who discovered them but also his two other brothers. He was beaten so badly that he spent over two weeks in the hospital, and then he returned to the same home where the abuse occurred. His parents sent him to another school in a different neighborhood, and he said that he never saw his friend again. To this day, he has no idea what happened to him. These traumatic events resulted in an immense fear; one that has spanned the course of his entire life resulting in a fruitless marriage and the need for him to hide his true identity.

I will be honest and admit that it took me a long time to respond to this email. I even wrote several drafts before finally sending my response. This was a new situation for me: Most of the folks who reach out to me are in the middle of dealing with homophobic or transphobic issues, but his situation was different because he was still struggling with his sexual orientation. I researched affirming counselors in his area and provided him with a list of folks whom he could reach out to. I was also able to find an LGBTQIA+ support group in his city. And I did my best to provide kind words. I stressed that he was not a mistake and was actually a victim of his situation. It was clear he was holding a lot of guilt about keeping this secret from his wife and that it was eating away at him and his marriage. It was important for him to realize that his options at the time of his marriage were few and far between given the immense cultural and family pressure that was put on him to marry and have a family. That pressure mixed with the severe trauma and physical abuse he faced as a child pushed him deep into the closet.

I emailed him these resources and words of encouragement, and he responded almost immediately, saying, “Thank you for everything you have brought to this world.” This statement brought tears to my eyes. I am happy to be a voice for those who cannot speak up. However, my simple response to his very complex problems hardly seemed like enough. I left this interaction feeling discombobulated. I had provided him with resources, but I was in no way equipped to provide anything further regarding his marriage. That was something he would have to work on himself. Was there more that I could have done? Probably not. Did I wish there was more I could do? Definitely.

Trudging forward and making progress

I write this update to share a very small portion of some of the stories I have encountered since openly discussing my experiences with conversion therapy. It crucial that more people gain the courage to share their experiences so the gravity of the impact of conversion therapy can be fully understood. The more folks share their story, the more we are all able to connect and support each other. We are moving in a direction that is positive, but we must continue on this path to dismantle this harmful, dangerous and potentially life-destroying practice.

I had no clue the impact that my story would have on others. It is heartwarming yet terrifying that so many people are able to connect with and relate to such trauma. It became incredibly clear that I had accidentally distanced myself from the overall desperation one feels when trapped in a similar situation. Writing my previous article helped me to relive my experiences in a way that was healing, and the responses to that article serve as a brutal reminder of how much more severe one’s situation can be. These responses also remind me that many folks are not as lucky as I am to have parents who were willing not only to admit their wrongdoings but also to work through those mistakes and come out as loving and supportive parents on the other side. They are a testament to personal growth and willingness to understand. These are qualities that we need more of in humanity, and ultimately, these are the qualities that will help end conversion therapy.

 

Benjavisa Ruangvaree Art/Shutterstock.com

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For more on laws relating to conversion therapy, see stonewall.org.uk/about-us/news/which-countries-have-already-banned-conversion-therapy and lgbtmap.org/equality-maps/conversion_therapy.

 

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Luke Romesberg

Luke Romesberg is a licensed professional counselor and certified alcohol and other drug counselor. He is a doctoral candidate in the counselor education and supervision program at the Chicago School of Professional Psychology. Currently, he works as the director of youth homelessness services at Center on Halsted and as a home study worker for the Adoption Center of Illinois at Family Resource Center.

 

 

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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.

Supporting transgender and gender-expansive youth

By Cortny Stark July 29, 2022

Transgender and gender-expansive (TGE) children and youth continue to experience marginalization, as institutions across the United States institute new oppressive policies that challenge and, in many cases, altogether prevent access to gender-affirming health care. TGE children and youth include young people between ages 3 and 17 whose gender identity is different from the sex designated at birth; the label “transgender” implies alignment with the gender binary (e.g., “I was designated female at birth and am a transgender man”), whereas gender-expansive identities do not align with the gender binary (e.g., “I was designated female at birth and am nonbinary — meaning that I am not a girl or boy”).

The realities of living as a TGE child or youth in today’s social, legal, educational and health-related environments are harrowing. Every day, new policies and legislation are introduced regarding TGE youth’s rights to access medically necessary gender-affirming health care, present as their authentic self at school, participate in extracurricular programs and sports, and have their appropriate name and pronouns honored in educational spaces.

As the parent of an incredible 12-year-old TGE child, my tolerance for the headlines is waning. I wake up each morning and check the latest news, and suddenly, I feel anxiety rising in my chest. I feel breathless and sick to my stomach. I have to put down my device and find a comforting television show or familiar rerun to watch before continuing with my day.

But we can do something about it. As helping professionals, we have an ethical obligation to support members of this community, as well as their caregivers and loved ones, and to advocate for dissolution of oppressive policies and legislation.

The current crisis

Despite over a decade of research and clear medical guidance supporting the efficacy of affirming social and medical interventions, several state and local governments across the United States have initiated anti-TGE legislation. In April 2022 alone, more than 20 pieces of legislation targeting the rights of TGE persons were introduced across the country.

On April 20, the Florida Department of Health released guidance on the treatment of gender dysphoria for children and adolescents, which states: “social gender transition should not be a treatment option for children or adolescents” and “anyone under 18 should not be prescribed puberty blockers or hormone therapy.” Alabama enacted a similar prohibition on affirming health care, but with more severe consequences for providers who violate the ban. The Vulnerable Child Compassion and Protection Act, which took effect May 8, states that health providers who provide gender-affirming puberty blockers or hormones will be charged with a Class C felony. Sanctions for violating the ban could include 10 years in prison or $15,000 in fines.

Red-Diamond/Shutterstock.com

Standards of practice from the American Academy of Pediatrics and World Professional Association for Transgender Health, however, continue to support social and medical transition as a necessary option for the health and well-being for many TGE youth.

Earlier this year, Texas Attorney General Ken Paxton issued an opinion stating that gender-affirming medical interventions, referred to as “elective sex changes,” are part of a “novel trend” and “constitute child abuse.” The fact that this opinion equates gender-affirming care with “child abuse” is of particular importance for helping professionals because this means credentialed providers are legally obligated to notify child protective services within 48 hours of learning that a minor is receiving gender-affirming medical care.

Many families and caregivers of TGE youth in Texas are now unable to access medically necessary gender-affirming interventions, such as puberty blockers and hormone replacement therapy. In addition, major TGE advocacy organizations are encouraging families and caregivers of TGE youth to maintain a “safe folder” — a collection of documentation that debunks the “affirming care is abuse” myth. The folder includes “carry letters,” which are documents written by licensed counselors, helping professionals and/or pediatricians who have worked with the youth. These letters contain the professional’s credentials, their relationship to the youth, a statement from the American Academy of Pediatrics supporting gender-affirming medical interventions as evidence-based and best practice, and an overview of the youth’s gender identity development process.

A call for advocacy

I share these current events not to stir your compassion but to make a request: Please act and advocate for TGE youth. You can pursue positive change in whatever realm you hold power, privilege or space. As a professional, I wear many hats, including assistant professor, mental health and substance use counselor, rehabilitation counselor, training facilitator and advocate. These professional roles provide a space for me to channel my anxieties and distress over these recent oppressive policies targeting TGE youth and work toward positive change.

For me, advocating for this population serves as a source of nourishment and a way to derive meaning from what feels like hopeless circumstances, and I hope that engaging in this work may do the same for my colleagues. Here are some ways helping professionals can better support the advocacy efforts for the TGE community:

  • Use a humanistic lens when working with TGE children and youth and recognize the client as the expert on their own experience.
  • Get to know the standards of care and research regarding evidence-based care with TGE youth. And make sure the research you consume and the information you share with others all come from prominent and reliable scholarly sources.
  • Elevate the voices of TGE youth. If you work with this population, know what prominent TGE community organizations provide safe and brave spaces for TGE youth, and be prepared to share this information with your clients. If you facilitate trainings or educational opportunities for responsive and competent practice with the TGE community, and you yourself are not a member of this community, use panels of TGE folx to share their experiences and expertise.
  • Inform people that gender-affirming social and medical interventions are medically necessary and are a key component of suicide prevention. According to a 2009 report by Caitlin Ryan, the director of the Family Acceptance Project, TGE children experiencing caregiver or family rejection are more than eight times as likely to have attempted suicide and nearly six times as likely to report high levels of depression than TGE youth who were not or only slightly rejected by their parents and caregivers. This report also found that TGE youth who were in accepting homes, with caregivers who supported social and/or medical affirming interventions, had rates of anxiety, depression, and suicidal ideation and attempts similar to their cisgender peers.
  • Advocate with and on behalf of these youth in their living environments, schools and greater communities; this may include educating others about the role of affirming health care in preventing suicide and improving TGE youth’s overall health and well-being, testifying against oppressive anti-TGE legislation, or supporting affirming legislation.
  • Honor the history of TGE communities by acknowledging the role of colonization and historical trauma in the erasure of histories of gender diversity. Recognize the systemic influence of adverse experiences in health care, schools, the legal system and other institutions on TGE individual’s ability to trust institutions. This history along with the major influential events in the lesbian, gay, bisexual, transgender and queer (LGBTQ+) rights movement are key to understanding the intergenerational trauma and resilience of members of TGE communities.
  • Keep learning! Developing one’s ability to provide culturally responsive care requires lifelong education and reflective practice. Sign up for workshops and continuing education regarding serving TGE individuals. And join consultation and supervision groups that focus on providing care to this population.
  • Connect and advocate. Connect with a local TGE advocacy organization and volunteer to support their efforts; if time does not allow for this level of engagement, consider donating to these causes to support their advocacy work.

As LGBTQ+ advocate, actress and film producer Laverne Cox once stated, “Each and every one of us has the capacity to be an oppressor. I want to encourage each and everyone of us to interrogate how we might be an oppressor and how we might be able to become liberators for ourselves and for each other.” At this point in history, it is critical that we as helping professionals identify how our actions contribute to the oppression of our TGE clients and do better. The health and well-being of an entire generation of TGE youth need helping professionals who are willing to use their power and privilege to elevate their voices and serve as liberators.

 

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Cortny Stark

Cortny Stark (she/her/hers) is an assistant professor and the substance use and recovery counseling program coordinator in the Department of Counseling and Human Services at the University of Colorado, Colorado Springs. She is also a telehealth therapist with the Trauma Treatment Center and Research Facility, where she provides trauma reprocessing and integration, clinical services for substance use and process addictions, and support for transgender and gender-expansive youth. Her research focuses on LGBTQQIA+ issues in counseling, integrative approaches to trauma reprocessing and integration, and substance use and recovery.

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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.

Helping counselors who serve sexual and gender minority youth

By Theodore “Ted” Carroll November 17, 2021

To best understand how to assist counselors, we need to address the ways that helpers are supported. The field of counselor education and supervision is composed of educators and practitioners who express support for clinical competence for practice and educational programs. The Association for Counselor Education and Supervision (ACES) is the entity that encourages program development for counseling education. ACES aligns with the 2016 Standards established by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP). CACREP promotes equity, diversity and inclusion in ethical practice, advocacy, leadership and academics. Multiculturalism and diversity are broad topics with specific implications that are included in CACREP’s standards.

In a 2019 article, “An interdisciplinary ecological framework: Intervention for LGBTQ interpersonal violence,” published in the International Journal of Bullying Prevention, Sharon Bruner and colleagues suggested that CACREP-accredited CES programs intend to explore ethical considerations for serving diverse groups. Pointedly, CES promotes helping licensed professional counselors (LPCs) better serve minority populations. Bruner and colleagues asserted that one challenge CES encounters in effectively supporting clinicians and counselor educators is that the ethical views of LPCs related to serving sexual and gender minority youth (SGMY) are virtually unknown. This lack of data prevents the development of appropriate counselor and educator supports.

Jared Rose and associates, in their 2019 article “Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling’s best practices in addressing conscience clause legislation in counselor education and supervision,” published in the Journal of LGBT Issues in Counseling, contended that although CES literature speaks to SGMY views of ethical factors, current journal articles that express LPC views are missing. As the authors highlighted, SGMY harms are increasing because of an apparent lack of clinical competence and awareness on the part of LPCs.

Pointedly, discovering what LPCs are thinking about ethical consideration for serving SGMY might help clinicians and educators overcome inadequacies and increase therapeutic progress for SGMY clientele. One might wonder why this specific qualitative data is missing from the current CES literature base.

Continuing education, politics and religion

First, CES programs lack awareness and training opportunities that might better equip LPCs for serving SGMY. The abundant choices for continuing education (CE) allow precedence of preference and exclusions of convenience. In other words, as health policy specialist Sari Reisner indicated in a 2015 volume of The Milbank Quarterly, clinicians often seek out enriching CE based on their historical interests. Therefore, sometimes established therapists decline new CE options because the information is perceived as extremely unfamiliar. Paradoxical to CE purposes, new ideas for CE are ignored for decades before becoming widely embraced, despite being based on cutting-edge research findings.

Second, Reisner suggested that some clinicians are closed-minded concerning nontraditional sexual and gender identifiers. Reisner implied that some LPCs are completely refusing services to SGMY based on political and religious beliefs. Although LPCs have a right to refuse service based on scope of practice considerations and conflicting personal beliefs, the 2014 ACA Code of Ethics sets clear referral standards. Reisner purported that the problem exists because some LPCs are not referring out at all, denying SGMY counseling access and violating professional ethics guidelines. Reisner continued pointing out that some of these same clinicians are not returning phone calls, emails or similar communications from SGMY inquiring about services.

Manivong Ratts and colleagues, in their 2016 article for the Journal of Multicultural Counseling and Development, “Multicultural and Social Justice Counseling Competencies: Guidelines for the counseling profession,” discussed CES pedagogical development that would more effectively support educators, counselors and counseling students. Intriguingly, they suggested appropriate communications and referral practices as part of the need for specific counselor training and curricula topics. Notably, CACREP-accredited CES programs would benefit from hearing what a thorough cross-section of the LPC population thinks about ethics for providing services to SGMY and the implications for practice and accessibility standards.

Why and how

Ratts and team suggested that clinicians and educators would benefit from knowing more about LPCs’ views concerning ethics implications for serving SGMY. In turn, SGMY clientele might benefit too. After all, as Reisner indicated, increased counselor effectiveness often leads to individuals’ substantial therapeutic progress.

Reisner and Ratts and colleagues encouraged future studies to focus on LPCs’ views regarding ethically serving SGMY. Furthermore, Reisner and Ratts and colleagues explained that the lack of LPC data incidentally helps maintain the status quo, highlighting that some SGMY clients are underserved, neglected or ultimately denied access to counseling services. In addition, these authors implied that poor access conditions enable less than adequate clinical services and increase SGMY harms such as homelessness, substance use, severe mental health symptoms and suicides.

However, based on information from existing CES research, the above indications are primarily derived from SGMY’s perspectives, not the perspectives of counselors. Although this synopsis includes some related professionals’ views on ethics considerations for serving SGMY, it excludes LPCs’ views. Reisner and Ratts and colleagues suggested that including LPCs’ ideas about ethics and counseling SGMY might expand ethical practices for clinicians, advance CES program development, and reduce serious SGMY harms. Arguably, knowing more about what LPCs think might save lives. At the very least, counselors and educators would be assisted, thereby more effectively supporting LPCs and CES.

It is likely that the majority of ethical dilemmas and the lack of adherence to ethics standards have more to do with LPCs not being equipped with the necessary awareness and training than it is a total lack of regard for SGMYs’ needs based on extreme political or religious beliefs. For the most part, counselors become professional helpers because they really want to help others. In fact, most counselors, educators and counseling students seek to better understand people and topics with which they aren’t initially familiar.

Outliers exist, however, and it is questionable whether LPCs would admit to feeling ill-equipped regarding awareness, training, referral standards or anything else. Perhaps simply asking LPCs questions about their experience serving SGMYs would produce more qualitative data that might help colleagues and inform CES program development. Direct ethics inquiries can be avoided while still gathering valuable information from LPCs. Of course, as mentioned previously, some clinicians might benefit from a thorough review of referral standards regardless of whether they are equipped or willing to counsel SGMY.

Ethical considerations and future research

Regarding the future research and need for focused studies, Myra Parker and team in their article, “Beyond the Belmont principles: A community‐based approach to developing an indigenous ethics model and curriculum for training health researchers working with American Indian and Alaska Native communities,” in the journal American Journal of Community Psychology, underscore that clarity of rationale for conducting research is paramount for research ethics. Furthermore, Parker suggests that a sufficient need for research precludes approval by institutional review boards. Indicatively, the need for knowing more about LPCs’ views is established: Educators, clinicians and clients are likely to benefit from simply knowing LPCs’ views about ethics factors for counseling SGMY.

Basically, the lack of information — a condition of the status quo that prevents best clinical practices — can be solved by ethically and responsibly gathering that data. LPCs’ views can be acquired without any significant risks to people, especially considering that qualitative interviews can be conducted via online videoconferencing platforms. These facts are essential for research protocol, as established by a 1978 National Commission’s publication, the Belmont Report, similarly discussed by Parker.

Identifying the research need and rationale for gathering new information, one might consider the immediacy of the need. LPCs lack training and awareness, which are incidentally enabling poor counseling conditions for SGMY. Who will step up to the plate and perform the needed studies? Delaying the suggested research would perhaps be the most unethical option.

Sharon McCutcheon/Unsplash.com

Practical considerations

Above all, knowing LPCs’ views about ethics for counseling SGMY would help people. Notably, the importance of assisting helpers should not be underestimated. As Lorelli Nowell related in 2017 in The International Journal of Qualitative Methods, the nature of helping others is draining and often leads to burnout. Similarly stated, if research is left undone, then the indicated problem continues. Consequently, the established need also would persist. Ultimately, the result would be that people suffer.

Pointedly, if the need persists, then LPCs would continue to be ill-equipped for best practices for counseling SGMY, and the indicated harms would continue. Incidentally, progress for LPCs and CES would be thwarted. On the other hand, as Ratts and colleagues indicated, if future studies address LPCs’ views of ethics for counseling SGMY, then the stated harms would be likely to decrease, and clinicians and educators would be better supported than they are now.

Intervention factors

New information from LPCs regarding ethical implications for counseling SGMY would likely present new theoretical considerations. Plus, new factors for theory might produce new ways for using interventions. For example, from a social constructivist view, collaborating with peers leads to solutions for interpersonal problems and personal growth.

Additionally, mindfulness interventions such as meditation practice might prove helpful in clinical sessions with individuals experiencing social rejection or low self-esteem due to sexual or gender identity challenges. In his 2019 article in The Counseling Psychologist, Ezra Morris supported this idea, suggesting that opportunities like these might be prime opportunities for theory and intervention advancements. For example, because mindfulness-based practices originate from constructivist tenets, Morris suggested that new applications inform educators of novel program developments. Furthermore, new application opportunities would potentially help the broad human services field, affecting change throughout various helping professions and grassroots humanitarian centers.

Forward momentum

Because CES supports counselors’ competence for practice and educational programs, drawing parallels from ethics and counseling SGMY to practice standards for serving other minority groups is appropriate for the field’s growth. For example, future studies could address LPCs’ views concerning marginalized groups such as those convicted of violent crimes or those who do not have health insurance. The subjects for consideration for future research focuses are nearly unlimited.

Of course, existing CES research should continue to guide future studies. Perhaps articles such as this one will trigger renewed interest in significant research gaps. First things first: helping LPCs to help SGMY helps CES and the broad human services field. The first step is finding out counselors’ views of ethics and serving SGMY.

 

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Theodore “Ted” Carroll and spouse, Tanya Carroll, operate a private practice in Spokane, Washington, that serves individuals, couples/families and children. Ted is a CES doctoral candidate with Capella University. His research specialization is counseling sexual and gender minority youth. Contact him through the Actualize Psylutions website.

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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.

Pride in practice: The journey towards LGBTQ+ counseling competence

By Jonah Friedman and Megan Brophy June 30, 2021

Lesbian, gay, bisexual, transgender and queer+ (LGBTQ+) people are marginalized, often at risk of discrimination due to sexual, gender and affectional minority orientations. While queer people experience heightened prejudice, research from the American Psychiatric Association has indicated a lack of suitable counseling for LGBTQ+ groups that would greatly benefit from increased services.

This need for appropriate queer counseling is amplified by the growing percentage of self-identifying LGBT people. The Washington Post recently published findings from a Gallup Poll revealing a 1.1% increase in LGBT adults from 2017 to 2020 and that 1 in 6 individuals ages 18-23 identify as LGBT. Given a growing queer population and the increased need for counseling, there is a clearly identifiable gap for qualified services.

Queer-competent counselors can help. Unfortunately, there is a lack of queer competence among many practitioners, perhaps because of the small number of available LGBTQ+ courses and training opportunities for counseling graduate students. Even when proactive and eager graduate students seek out dedicated coursework, internships and training experiences in queer settings, viable options are limited. The cycle of limited to nonexistent queer-accessible counseling resources is perpetuated without available training experiences. How can we become LGBTQ-competent counselors when so few opportunities exist for education and practice in this area?

The queer experience

We live in a society that gives preference to white, Christian, male, cisgender, and heterosexual people. To retain power, both intentionally and not, these dominant identities often oppress any divergence. Youth are commonly indoctrinated to believe that departure from societally deemed normative standards, such as same-sex attraction or nonbinary gender, is deviant or wrong. This belief system often intensifies with age and can lead to the discrimination and oppression of queer people throughout the life span. To remain safe in today’s heteronormative and cisnormative society, many queer individuals hide their identities. Doing so is often the only way for them to be treated equally to their straight, cisgender counterparts.

Researchers Laura S. Brown and David Pantalone showed that the nature of constant secrecy, dissonance and struggle to conform adversely affects mental health. The Substance Abuse and Mental Health Services Administration has found that sexual minorities who experience exclusions from society have higher rates of mental health disorders, major depressive episodes and substance abuse. The Trevor Project’s data even indicate that queer youth experience higher rates of suicidal ideation.

Additionally, Darrel Higa et al. from the University of Washington found that when LGBTQ+ people choose to share their identities with parents, guardians, schools and workplaces, they are often met with rejection and discrimination. This is seen through higher rates of homelessness and increased unemployment in comparison with heterosexual individuals. Despite LGBTQ+ people experiencing heightened mental health disparities, queer clients often find unsupportive counseling services. 

Counselor competence 

LGBTQ+ clients benefit from counselors and mental health agencies that provide acceptance and validation through queer counseling competence. The Society for Sexual, Affectional, Intersex and Gender Expansive Identities (formerly known as the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling), established a task force in 2012 that outlined queer-competent counseling behaviors. The competencies touch on queer human growth and development, social and cultural foundations, helping relationships and more. The same group released competencies for counseling transgender clients in 2009. These resources, while important for agencies to utilize, have not been updated in a decade and would benefit from the inclusion of newer relevant queer research.

Having queer-competent counselors in all mental health settings is crucial to fostering open discussion and disclosure of LGBTQ+ client identities. A survey by the Center for American Progress shows that a lack of trust exists within the LGBTQ+ community for health care systems. It is likely that counselors will need to continually gain the trust of queer clients due to their historically negative health care experiences and traumas. To achieve such trust, counselors should provide appropriate services to LGBTQ+ clients as directed by the queer counseling competencies and the American Counseling Association’s ethical obligations of beneficence and nonmaleficence.

Paper guidance on LGBTQ+ competence exists, but the field is obligated by these same values to provide more than the prevailing “self-teach” approach. When queer competence is effectively implemented, the resulting safe spaces, open dialogue and unconditional positive regard will encourage more LGBTQ+ clients to show up authentically. Findings from Edward Alessi et al. revealed that a queer affirmative approach to counseling resulted in a stronger therapeutic alliance and increased well-being for LGBTQ clients. There is a great need for graduate students and current practitioners to better learn queer counseling competencies.

Missing coursework

To gain LGBTQ+ competence, graduate students and practitioners must engage in coursework and continuing education on queer theory. Furthermore, they must partake in related training experiences. Many students and practitioners face obstacles to finding such offerings. The following details our experiences (Jonah Friedman and Megan Brophy) as we struggled to find appropriate training in this area.

Jonah entered a master’s in counselor education graduate program in August 2020. In an early academic advising session with faculty, he expressed interest in LGBTQ+ counseling. When seeking out classes in gay affirmative therapy and related theories, Jonah was informed there were no related course offerings at the college he attends. An institution that so strongly emphasizes its core tenet of multicultural competency had no classes specifically on LGBTQ+ counseling. While regretful, this is the case at a majority of universities offering master’s in counseling and related degrees. The resulting options were to forgo such classes or to transfer in pertinent elective credits from one of the few programs with queer counseling coursework. Eager to obtain such training, Jonah began the search to find other CACREP-accredited graduate programs offering courses in LGBTQ+ theoretical approaches.

In New Jersey, there are 12 CACREP-accredited universities offering graduate counseling degrees on a variety of tracks. A review of these programs and their course directories revealed only four clinical mental health programs regularly offering electives on sexual issues in counseling or gender issues. None of these courses was explicitly dedicated to the study of working with LGBTQ+ clients. The remaining programs did not list relevant electives or did not offer any form of an LGBTQ+ counseling course. This absence may be attributed to CACREP not requiring the integration of LGBTQ+ counseling education to earn accreditation for clinical mental health programs.

To take appropriate courses, Jonah applied to Southern Methodist University (SMU) in Dallas. The school has a counseling program that boasts an affirmative therapy with LGBT clients track. Jonah has since enrolled as a nonmatriculated student in two electives: “Affirmative Therapy with LGBTQ+ Individuals: Advocacy Across the Lifespan” and “Affirmative Therapy with Transgender and Gender Non-Conforming Clients.” Although the experiences have been enlightening, allowing for exploration of sexuality and gender through a deeper and more critical lens, it was a difficult and arduous process to obtain this theoretical training. The time, costs and effort of taking these classes at a second institution only adds to the hardships created by the lack of initial course offerings.

Additionally, Jonah was able to take courses online and remotely at SMU only because of COVID-19 guidelines. During regularly structured semesters, such courses are in person and unavailable to out-of-state students. Furthermore, Jonah enrolled in these courses proactively; students not seeking out queer counseling coursework will be minimally exposed to these crucial theories. When such courses are not offered or required, there is an inherent implication that queer theory is not important to CACREP or our practice as counselors.

Lacking clinical experiences

Even if LGBTQ+ courses are secured, counseling students must then engage in queer-relevant training experiences to build practice competency. This approach follows the logic of formative development within the counseling field: first learning the theories through coursework, followed by application during clinical experiences.

Megan Brophy’s experience finding an LGBTQ+ based internship as a graduate student proved challenging. Throughout the states of New Jersey, New York and Pennsylvania, Megan found only four sites offering exclusively LGBTQ+ oriented counseling. To secure competitive internships at such sites, students often begin applications and interviews up to six months prior to the start of a program. At one site in Philadelphia, the application window was open only for a single month. Many other sites accept only one to three interns annually. This highly selective approach for interns greatly increases the already difficult endeavor of finding a relevant training position. The limited funding and logistical roadblocks for hiring interns and licensed practitioners at these sites hinder counseling students from gaining the clinical experiences necessary to become queer-competent counselors. Students struggle to structure their degrees around obtaining these queer-focused internships while working to stay on track to graduate.

In her search for internships, Megan called a variety of LGBTQ+ community centers in New Jersey to assess the availability of internship opportunities. She discovered that among those offering services, most were limited to support groups facilitated by nonlicensed professionals. In part due to a lack of funding and resources, services were more related to social gatherings, legal referrals and Pride celebrations. Resultantly, queer youth have severely limited access to appropriate counseling services. Relatedly, graduate students attending CACREP-accredited programs cannot obtain internships that meet accreditation requirements for supervision without licensed clinicians at such sites.

Even when qualified services are available, they are often niche and unrepresentative of the greater queer community. One such counseling opportunity is offered through a residential living program available to queer, homeless adolescents in Ewing, New Jersey. While homelessness is critical to address, it is an extreme situation for LGBTQ+ youth to find themselves in. We must also consider queer youth not displaced who are still looking for mental health services.

Finally, we must consider how the lack of availability and accessibility to LGBTQ+ sites directly affect our clients. Traveling great distances to the nearest LGBTQ+ counseling center is a privilege that many do not have. We cannot expect or require our queer clients to travel so far to attain mental health services. Queer-identifying youth almost never have this option without the help of a supportive friend or family member. Beyond that, given school and homework obligations and involvement in extracurricular activities, they may not have the time to travel long distances for services.

While the recent influx of online mental health services stemming from the COVID-19 pandemic has made counseling more widely available, online counseling within an unsupportive home environment may be harmful for LGBTQ+ clients. In such situations, queer clients may not be able to safely disclose information regarding their sexual or gender identity. This emphasizes the work that still needs to be done within the counseling field to create more queer-inclusive spaces with queer-competent counselors.

Understanding queer identity

As counselors, we have a duty to be multiculturally competent. The Multicultural and Social Justice Counseling Competencies, developed by the Association for Multicultural Counseling and Development, detail the layers leading to more inclusive counseling: counselor self-awareness, client worldview, the counseling relationship, and advocacy interventions.

While our field has made strides in the integration of diversity, there is more to be done in helping queer clients. To train and sustain queer-competent counselors, we must make a commitment to better understand the multifaceted aspects of queer culture, identity and relevant terminology. Beyond this, counselors can engage in continued research and relevant literature with the community, including resources provided by leading queer organizations (e.g., The Trevor Project, GLSEN). The understanding of queer identity and worldview is foundational in effectively working with LGBTQ+ clients and empathizing with their unique experiences.

Active advocacy

Rainbow Black/Shutterstock.com

ACA has established a nondiscrimination policy banning all forms of harassment, including protections for transgender, gender nonconforming and LGBTQ+ individuals. We as a profession must move past this passive protection and evolve as active advocates. Practitioners can act with and on behalf of their queer clients on the micro-, meso- and macrolevels of advocacy.

On the microlevel, counselors may work with queer clients to continually affirm their identities. On the mesolevel, advocacy might take the form of working alongside local school systems to organize LGBTQ+ support groups or arranging professional development for staff. On the macrolevel, practitioners can become involved with legislation that is supportive of LGBTQ+ individuals and communities. All three levels of advocacy are required to make a difference in our current climate.

Graduate course offerings

Gov. Phil Murphy of New Jersey recently signed into law LGBTQ+ inclusive curriculum legislation, following the states of California, Colorado, Illinois and Oregon. Out of 50 states, only five have recognized the importance of a queer-inclusive approach to education. Across New Jersey, boards of education have begun to integrate the accurate representation of queer individuals and history into curricula.

So many of the accredited institutions of higher education in the same state have yet to adopt similar coursework. These schools, which are training the counselors of the future, need to offer more classes on queer theory. In doing so, all graduate counseling students will be exposed to basic LGBTQ+ terminology and culture. This integration of queer curriculum will take queer counseling skills past the point of specialization.

LGBTQ+ oriented sites

While it would be ideal to open queer-focused counseling sites across every state, a more realistic plan would be for existing agencies to introduce LGBTQ+ services. For example, High Focus Centers in New Jersey, known for their outpatient substance abuse programs, recently added an LGBTQ+ track addressing substance abuse, queer wellness, self-esteem, empowerment and relational skills. Other sites can commit to adding queer tracks within their programs to allow for more internship opportunities and training in queer-competent counseling. In turn, sites will become more welcoming to queer clients.

A better future

By gaining basic queer counseling competence, advocating for all LGBTQ+ people, enhancing counseling curriculum to be queer-inclusive, and integrating queer support services at all agencies, our field can significantly improve the counseling provided to LGBTQ+ people. We must all become queer-competent counselors and the agents of change in our increasingly progressive field.

 

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Related reading: See Counseling Today‘s June cover story, “Listening to voices of color in the LGBTQ+ community

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Jonah Friedman is a Master of Arts in clinical mental health counseling candidate at the College of New Jersey. He completed his undergraduate studies at Tulane University, where he first discovered his passion for helping others and the value of counseling. Inspired by his current work with the Trevor Project, Jonah hopes to eventually work as a practitioner utilizing an LGBTQ+ affirmative approach. Contact him at friedj11@tcnj.edu.

Megan Brophy (she/her/hers) is a recent graduate from the College of New Jersey. Her work is guided by a passion for social justice and advocacy for marginalized communities. Contact her at brophym1@tcnj.edu.

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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.

Listening to voices of color in the LGBTQ+ community

By Laurie Meyers May 26, 2021

It has been 52 years since the Stonewall uprising — a multiday protest that began when police raided the Stonewall Inn, a gay bar located in Greenwich Village in New York City, in the early hours of June 28, 1969, and began arresting patrons and employees. The bar was a haven for the LGBTQ+ community, and the raid — purportedly for liquor license violations — was one more in a pattern of police harassment of queer and transgender establishments. 

Many in the LGBTQ+ community credit Marsha P. Johnson, a Black transgender woman and frequent patron, with throwing the first brick that sparked the uprising. However, in interviews in the 1970s, Johnson said she didn’t arrive until the clash was underway. Other stories had Sylvia Rivera, a Black and Latina transgender woman, throwing the first Molotov cocktail. Rivera later said she was in the crowd throwing coins before the cocktails began flying. LGBTQ+ historian Charles Kaiser believes that Stormé DeLarverie, a Black biracial lesbian and drag king, sparked the resistance by throwing the first punch. 

People may not agree on how the uprising began, but one thing is clear: Trans and queer women of color were at the forefront of the gay liberation movement that emerged from Stonewall. Johnson and Rivera also helped found the group STAR (Street Transvestite Action Revolutionaries), which offered housing to homeless and transgender youth. 

Their contributions to the LGBTQ+ communities are starting to be recognized. The East River State Park in Brooklyn was renamed Marsha P. Johnson State Park, and in 2019, New York City announced plans to build monuments to honor Johnson and Rivera. They will be the first permanent monuments of transgender women in the state of New York. The monuments are also part of the city’s effort to address the gender gap in public art. 

But the gap stretches beyond gender. Over time, the contributions of Johnson, Rivera, DeLarverie and many other queer and trans people from Black, Indigenous and people of color (BIPOC) communities have been overshadowed by white narratives and priorities. In the eyes of many, the face of the LGBTQ+ community is still too often exclusively that of white, gay, cisgender men. 

Often, nonwhite queer and trans people do not feel included — or necessarily even safe — within the larger LGBTQ+ community. As in other spaces in a system built on white supremacy, racism is all too prevalent. People who are part of communities across the BIPOC spectrum also face increased oppression and unique challenges because of the intersection of their cultural and LGBTQ+ identities. Although the term BIPOC is meant to be inclusive, sometimes it can be used as a catchall term that — intentionally or not — erases individual communities. What follows are professional insights from seven Black, Latinx, Indigenous and Asian counselors on how racism and oppression affect clients who identify as both ethnic/racial minorities and LGBTQ+.

Creating safe, inclusive spaces

Historically, white people have been the ones to decide where or how people of color fit into their world, observes Adrienne Erby, an assistant professor of counselor education at Ohio University. Her research focuses on intersectionality and racial, cultural and LGBTQ+ issues.

In a wider society that consistently looks to white, cisgender men to lead, LGBTQ+ communities can replicate that same dynamic, Erby says. White, gay, cisgender men may not lead all aspects of the LGBTQ+ movement, but they  have become the face — and the voice — of it, she notes.

“Who gets to have a voice? Who sets the agenda for activism?” Erby asks. Navigating racism and genderism — particularly among Black transgender women — increases the risk of experiencing violence or being killed, she explains. Constantly questioning one’s safety creates different priorities — such as sheer survival, notes Erby, an American Counseling Association member. For BIPOC queer, trans and nonbinary individuals, the interaction of racism and genderism affects even the most basic things, such as the ability to find and keep employment, health care and safe housing.

Trans activists note that the addition of transphobia on top of racism compounds the problems with employment and housing. Transgender women often have no place to go when they need shelter or are in danger because most homeless and domestic violence shelters do not accept trans individuals. 

Disrupted education is also a major issue for LGBTQ+ individuals who are BIPOC. Trans and nonbinary adolescents — particularly those of color — frequently drop out of school to escape race- and gender-based bullying by peers and even teachers, in addition to being pushed out of school through disciplinary measures that disproportionately affect BIPOC students, Erby says. 

Counselors can be crucial advocates by challenging policy and procedure and function as “safe adults” for these students, she emphasizes. At the same time, Erby cautions counselors to resist the desire to “reframe” legitimate issues such as racism, heterosexism, genderism and transprejudice. Rather than helping, these approaches serve as barriers to open communication, especially among queer, trans and nonbinary people of color. BIPOC are more likely to respond to honesty and authenticity, she says. 

“In our homes, most of us have learned to read very quickly if a person is someone [we] can talk to,” Erby says. “Instead of expecting people to come out to us, we need to show that we can be invited in.” Inviting someone in — putting the power with the student or client to share what they choose — is essential to building trust, she stresses.

Counselors are often trained to assess through questions that are information driven rather than narrative driven. “We ask for the information that we need to have, which is not a bad thing — it’s essential — but we also need to be asking broader questions,” Erby says. So, instead of just confirming that a client is living with their family, for example, counselors should invite clients to tell them more about their families, she advises. 

Erby recommends that counselors get a sense of who clients are not just in the moment, but in their lives outside of counseling. Who are their family members? Where did they grow up? What is their relationship to a faith community? “It’s important that we talk about the things that shaped [clients], like family, school, race, faith, spiritual belief and how [they] identify,” she says.

“We [also] have to broach the issues of race, culture and gender from the start and throughout our relationship,” she asserts. “I always make sure to mention race, gender, affectional and spiritual identity. These are things that people may not bring up themselves.”

Pushing past a white-centric narrative

Tameeka Hunter, an assistant professor of counselor education and supervision at the University of Arkansas, believes one of the most consequential elements in understanding and centering the diverse stories of the LGBTQ+ population is to stop using white experiences as a benchmark. For example, coming out of the closet is a white, patriarchal construct, she explains. Western (white) culture is an individualistic one that places more emphasis on individual desires and independence than on collectivist or relational cultures. However, as Hunter points out, most of the cultures across the BIPOC spectrum are relational, so the community is a core part of the person’s identity.

“Coming out is not possible for everyone,” says Hunter, an ACA member whose research focuses on marginalized populations, including LGBTQ+ and disability populations. “It may not be safe to do so. ‘Coming out’ may cause significant losses.”

For example, Black culture is a relational culture that honors its elders, and the community’s support is an essential tool in surviving racism, Hunter says. Coming out may jeopardize the person’s place in the community and threaten their source of social and financial support and safety, she notes. 

Part of being an LGBTQ+ affirming counselor requires examining one’s own biases about issues such as gender, affectional identity and race, and understanding the complexity of being at an intersection, says Hunter, who is a diversity speaker and researcher. 

In addition to making sure their intake forms are inclusive, including categories for racial, affectional and gender identity and pronouns, counselors need to let clients know that they’re open to talking about religion and spirituality, because as Hunter points out, that can be a central part of many Black people’s lives. And if an LGBTQ+ client’s family believes that being a sexual minority is sinful, it could create serious identity issues for them. Letting clients know that they can safely talk about religion/spirituality in session “creates a space for them to tell you, ‘I’m in conflict with my family’ or ‘I might believe that my sexuality is a sin or an abomination,’” she explains.

In situations in which clients are struggling with being gay and fear that their family will reject them, counselors should assess the client’s support system, Hunter says. Is there anyone they can talk to in the family? If not, counselors can help clients expand the way they think about support. For example, LGBTQ+ people frequently have “found” families — nonbiological kinships that provide a supportive environment. Hunter helps clients find supportive networks by asking them about places or people who bring them a sense of peace or joy. They can also choose to whom they want to disclose their LGBTQ+ identity. That may mean being open with some family members but not with others, she adds. 

“People of color who are also LGBTQ+ have a tendency to find community with those who share [their] sexual identity, racial identity or another marginalized identity,” she says. “That’s a way to hold on to … culture. Part of finding community is holding on to the validity of our experiences.”

People with multiple marginalized identities are constantly forced into presenting little bite-sized pieces of themselves. Being among like-minded people is a way of finding relief from the strain of holding back so much of one’s self, she says.

But Hunter also cautions that it’s all too easy for counselors to indulge in what she calls “disparity porn” — stereotypical narratives such as being Black makes someone more prone to substance abuse or that Black families are typically less accepting of LGBTQ+ family members or are more homophobic. “While it is important to acknowledge health and other systemic disparities so that we can educate future counselors and support clients contending with those concerns, many times we disproportionately attend to those disparities,” she says. “Disparities and systemic oppression are important topics, but there needs to be balance in how often these topics are covered.” 

Hunter recommends that counselors also focus on positive affirming concepts such as resilience. “We can celebrate those who are thriving in the community by illuminating their stories,” she says.

Hunter concludes by emphasizing our shared humanity: “I strongly believe that our liberation is bound together — all marginalization from systemic suppression is bound together — even if we do not share the same marginalized identity.” In other words, she thinks that when the most stigmatized among us — such as Black transgender women — are free, then we all, as a society, will be free.

Unfracturing identity

When people engage with the LGBTQ+ community, there is often an initial feeling on the part of those who have been marginalized that this part of their identity has finally been validated, and they feel safe, says Misty Ginicola, a licensed professional counselor (LPC) who specializes in counseling LGBTQ+ individuals. Often, however, those who are Black, Latinx, Asian, Indigenous or other people of color “soon learn that [they] are not completely safe,” she says.

Colonization and the oppressive system it established is everywhere, Ginicola notes, so racism and misogyny are also entrenched in the LGBTQ+ community. “It hurts worse when it comes from a space where you think you are safe,” she observes.

Mirroring may be a developmental psychology concept applied primarily to children, but Ginicola, a professor in the clinical mental health counseling program at Southern Connecticut University, thinks that adults instinctively do it too. “We look for people who mirror and validate [us],” she says. “For those of us who have different marginalized identities, we never get a true mirror. … No matter what — I think I can speak personally from this angle — there won’t be a community where you have all of your marginalized identities [mirrored].” 

It’s not just that no one community can encompass every aspect of a person; it’s that when it comes to marginalized identities, there will always be environments that are not only unwelcoming but also hostile, explains Ginicola, an ACA member and co-editor of the ACA-published book Affirmative Counseling With LGBTQI+ People. For safety — and many other reasons — it may be necessary to suppress parts of one’s identity, which may cause a person’s identity to fracture, she says.

To remain whole, the person must cultivate a home and community within themselves, Ginicola notes. Her goal is for clients to be able to say, “If I don’t feel welcome somewhere, I’m not going to go there. I won’t fracture to fit in anymore.” But getting to a point where the client can say that requires examining all of their identities, Ginicola says. 

She helps clients explore the boxes they are trying to fit into by asking them, “What is it that you think people expect you to be? Do you want to be that?” For example, Ginicola has a client who is queer and grew up in a rigid evangelical family. Because the client still has inner critical voices connected to his strict religious upbringing, she works with the client to explore where those voices come from and whether those voices reflect his value system or someone else’s. Counselors have to look at all of those areas that have shaped the client’s identity, even if it makes them uncomfortable, she says. 

“Colonizing beliefs and the value system that we have in place as a culture is a lose-lose for most people — even for people who do seemingly fit,” she says. “We all walk around fractured in some way, whether it’s about your physical experience [or] mental health diagnosis. We’ve been taught to pull those things inward in order to fit in.” 

“I think the other thing we have to tackle as individuals and as a society is binary thinking,” Ginicola adds. “Everything [is] black and white, good and bad. Our society has not prepared us to have complex emotions.” 

Navigating intersections 

An element of cultural misappropriation exists among the white LGBTQ+ community, says Christian Chan, an assistant professor in the counseling and educational development department at the University of North Carolina-Greensboro. One sentiment he often hears from clients who have at least one marginalized identity is that “I’m absolved from being microaggressive. I’m absolved from acknowledging that these other forces are at play. I can’t be racist.” But people with marginalized identities can still act in racially aggressive ways, he says.

In some ways, white LGBTQ+ individuals are established as the “norm and ideal,”  notes Chan, an ACA member whose research focuses on intersectionality, social justice and the LGBTQ+ population. Their white privilege helps mitigate some of the oppression they face, despite being queer or trans. 

Chan also points out that those from BIPOC communities often grow up in collectivist cultures. In Black, Latinx, Indigenous, Asian and other communities of color, there is a sense of kinship and sharing that helps them bear the weight of hatred and injustice, which is always present but has been particularly visible over the past year, he says. But if identifying as LGBTQ+ makes a person unwelcome in their culture or family and their race/culture is not widely accepted in the queer and trans community, where do they turn? What happens when they are disowned not only from their family but also from their culture? Chan says the sense of isolation that can occur from being physically in a community but not feeling a part of it can be profound. “It’s a dance of hypervisibility and invisibility,” he says. 

Race also intersects with genderism and heterosexist norms, Chan points out. Queer men have internalized many of the stereotypes of masculinity prevalent in straight culture. They not only view being “too feminine” as taboo, but also often have an ideal of hypermasculinity, he says.

Stereotyping and fetishization of BIPOC bodies are widespread in clubs and on dating apps, Chan continues. For example, on heterosexual dating apps, Asian men are often perceived as less masculine because of prevailing stereotypes in queer culture, he says. In contrast, Black gay men are fetishized because they are often perceived as hypermasculine. Blatant racist comments are also common on dating apps, he adds.

It is important for counselors not only to acknowledge that a client’s LGBTQ+ and BIPOC identities are connected but also to understand how the client navigates these overlapping forms of oppression, Chan stresses. He advises counselors against assuming that the reason a client is in their office is related to their racial, affectional or gender identity. But he also urges counselors to let clients know that they are in a safe space where they can talk about all of their experiences because internalized oppression is negatively linked to mental and physical well-being. Chan notes that affirming intersections can actually buffer negative encounters and reduce distress. Counselors can help clients see that there is strength in navigating their intersections because it can build resilience and even be lifesaving, he says.

Becoming an accomplice

“One of my favorite sex educators, Ericka Hart, will frequently note that queerness does not absolve racism,” says Alandria Mustafa, an LPC at Sula Counseling in Goose Creek, South Carolina. “White LGBTQ+ folks perform Blackness, especially Black femininity, through a variety of mannerisms and the use of AAVE [African American Vernacular English] and slang terms that were born and bred in the Black queer community, while also invalidating and gaslighting queer and trans Black people, who are attempting to name and seek acknowledgment for harm done within the community.” 

“White LGBTQ+ people tend to believe that because they are also queer, they have a comparable oppressive experience to queer and trans Black people,” continues Mustafa (pronouns they/them/their). “This couldn’t be further from the truth, but attempts to explain and explore how this is false assumption are usually complicated by white fragility.” 

Mustafa stresses that white LGBTQ+ people need to listen to queer and trans Black people when they say that anti-Black attitudes are harming them, and they need to do the work of unlearning anti-Blackness. “Queer and trans Black people would best benefit from mutual aid and true accomplices, not just allies. Accomplices are willing to leverage resources and power in pursuit of true equity and accountability,” they add.

When working with clients who have been rejected by their communities of origin because they identify as members of the LGBTQ+ community, Mustafa encourages them to acknowledge the lack of acceptance as an internalization of white supremacy in individual Black communities. 

“The idea that we are disposable is a direct result of being disposed of over many, many years,” Mustafa explains. “This conversation usually supports the externalization of transphobia and queerphobia, so we can recognize that rejection is a product of generational and ancestral trauma.”

Mustafa also encourages clients to challenge their definition of family and the belief that families must be biological. “Queer and trans BIPOC have always been intentional and thoughtful around creating family dynamics amongst one another as a means to keep each other safe and provide support,” they say. “So, I typically invite the development of chosen family and social support systems as safe familial dynamics that can always be created and nurtured outside of those we share a genetic makeup with.”

Racism within the LGBTQ+ community also leads to extreme marginalization of transgender (particularly Black transgender women) and nonbinary people, who are at the greatest risk of violence and murder, Mustafa says. 

“It’s important to acknowledge that this [marginalization] is due to transphobia and anti-Blackness, both of which are a result of white supremacist rhetoric and the harmful nature of the gender binary,” Mustafa emphasizes. They point out that “trans and nonbinary folks are also less likely to engage in support services — whether this be mental/emotional health services or physical and reproductive health services — and are least likely to access a variety of community programs.” The reason for not accessing these services does not stem from a lack of desire or willingness, Mustafa says. It comes from “a variety of systemic barriers that make it incredibly challenging to access care that is safe.”

Mustafa suggests the following ways that counselors can support transgender and nonbinary people:

  • Offer some pro bono or sliding scale services to ensure that transgender and nonbinary people have access to mental health care. 
  • Do not charge for documentation that is required for transgender people to pursue affirming medical care. 
  • Vet providers who claim to provide gender-affirming medical care before referring clients to them. “We are responsible to our clients, and even more so to our clients who are trans, to ensure that the referrals we use are practicing affirming care and are not likely to cause harm to our clients,” Mustafa stresses.
  • Include gender-neutral language on websites, intake documents and signage in the office (on bathroom doors, for example).
  • Continue to learn and self-critique one’s perceptions about gender and sexual identity. Mustafa adds that counselors should challenge how they perceive gender in their personal lives as well. Counselors cannot say that they believe in affirming gender diversity and gender expansiveness in the therapeutic space and then present with rigidity and a lack of flexibility in the personal space, they say.
  • Advocate for clients. “The personal is political,” Mustafa says. “Trans folks of color are highly politicized, solely based on their intersecting identities.” It is virtually impossible to properly and wholeheartedly serve a population at the intersection of a variety of marginalized identities while also claiming neutrality about legislation and policies that cause harm, they point out. Mustafa stresses that counselors cannot stand by while working with a population of people who cannot access proper medical care because of anti-trans legislation and policies or who are murdered and discarded for simply existing.

Being LGBTQ+ and Latinx

One of Roberto L. Abreu’s principal areas of research is with the parents and families of Latinx queer and trans people. What he has found in his research challenges the belief and stereotype that Latinx families are not accepting of their LGBTQ+ family members. The families whose stories he highlights in his research are interpreting Latinx cultural norms in ways that are affirming of their LGBTQ+ children.

“Like in other collectivist cultures, there is a strong emphasis on community and family among Latinx people,” says Abreu, an assistant professor of counseling psychology and director of the Collective Healing and Empowering Voices through Research and Engagement (¡Chévere!) lab at the University of Florida. “Family is central to everything. The idea is that it doesn’t matter what happens; family comes before anything else,” he says. 

Gender norms are also important in Latinx culture, Abreu notes. Specifically, mothers or those in motherly roles are seen as the keepers of the culture. The mothers he spoke to often reported that one of the reasons they accept their LGBTQ+ child is because it’s their duty as a mother, which includes being self-sacrificing and putting the well-being of their children above all. 

Abreu points out that even Latino male gender norms, which are often described in terms of rigid views of masculinity, has layers. Part of Latino male gender norms involves keeping one’s word, being emotionally in touch with one’s family and setting a good example for the family unit — all characteristics associated with caballerismo (the idea of a man as the family provider who respects and cares for his family). For example, some of the fathers Abreu has spoken to describe working on their own feelings and emotions regarding their LGBTQ+ child and coming to a place of acceptance to ensure that their other children and family members also accept the LGBTQ+ child. 

“Latinx culture also places a heavy emphasis on the idea that everyone should be afforded dignity,” Abreu says. He has found that parents of LGBTQ+ children often interpret this as their child’s right to love whomever they wish.

Abreu also studies issues faced by Latinx transgender people and says access to health care is a challenge for this population. “The barriers go beyond simply getting to the doctor’s office. Not having forms in their native language and [experiencing] negative interactions with office staff are just two examples of the types of discrimination and hostile environments that Latinx transgender people face before they even see the doctor,” Abreu says. 

“Health care providers also frequently attribute everything to the patient’s identity as transgender,” Abreu notes. For example, a person might come in with a cold and be asked intrusive questions about being transgender. “Medical staff also tend to hyperfocus on parts of the trans women’s identities, such as making assumptions about what they do for a living,” he says.  

When Abreu asked study members what services they most needed, they named trans-specific health care sources, financial resources, spaces for transgender homeless people, addiction care, and help for the undocumented such as legal and documentation expertise. Abreu also believes there should be a center that offers education for family members to understand what being LGBTQ+ means. And all of these resources need to be offered in Spanish, he adds.

Acknowledging and advocating for BIPOC LGBTQ+ clients

“It is imperative to understand not only LGBTQ+ experiences, but [also] how that intersects with race/ethnicity,” says Tamekia Bell, an assistant professor at Governors State University in Illinois. “We are not monolithic individuals; we have multiple identities. However, sometimes we struggle or ignore the multiple identities that people have.” 

“I do believe some people of color may feel shut out by the larger LGBTQ+ community,” Bell continues. “BIPOC LGBTQ+ individuals need the community to not only speak out against hatred around LGBTQ+ issues, but [also] systemic racism and dismantling white supremacy. Again, the focus needs to center on all members of the community, not just the privileged ones.”

Bell, an ACA member whose research interests include multicultural competency surrounding individuals with disabilities and LGBTQ+ individuals, cautions counselors that not all individuals who identify as LGBTQ+ have the same experiences. “It is important for counselors to have our clients guide us in that discussion and not assume [that] because they identified as BIPOC and LGBTQ+, they will have struggles with who they are,” she says.

Society as a whole sends constant and consistent messages to BIPOC LGBTQ+ individuals that they are not valuable, notes Bell, chair of the Society for Sexual, Affectional, Intersex and Gender Expansive Identities’ Queer & Trans People of Color Committee. It is society that needs to change, she stresses, yet BIPOC LGBTQ+ individuals are expected to adjust to the society they live in. “This is where our work outside the therapeutic spaces is so crucial,” she emphasizes. “We can provide tools, resources and support for our clients, but ultimately, they go back into the world that tells them they are unworthy. In order to truly help our clients, we have to work to dismantle the systems that make our clients feel undervalued and unworthy.”

Bell advises counselors to seek out resources and readings to help them learn how to provide ethical and culturally competent care to BIPOC LGBTQ+ individuals. By doing their own work, counselors avoid placing the burden on BIPOC LGBTQ+ counselors, clients and community members. “The work is not always easy, and I sometimes find myself saying or doing the wrong thing,” Bell admits. “In those instances, I acknowledge my ignorance, apologize for my transgression and commit myself to continuing to do better in the future.” 

When working with LGBTQ+ individuals, Bell acknowledges her privileges and asks that they call her out if she says or does something offensive or inappropriate. “Because I know and understand my worldview is different, I am more intentional,” she says. “I do not mind the work because I want to live in a world, and have future generations live in a world, where they are honored and valued for who they are and being their authentic selves.”

Daniel Samray/Shutterstock.com

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@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.