Lbian, Gay, Bisexual, Transgenr, Queer, and Intersex (LGBTQI+) | SAMHSA

Contents:

• ISSU ARISG PSYCHOTHERAPY WH LBIAN, GAY, BISEXUAL, AND TRANSGENR PATIENTS
• APA’S GUIL FOR PSYCHOTHERAPY WH LBIAN, GAY AND BISEXUAL CLIENTS: THE FUNDAMENTALS FOR PRACTICE
• PSYCHOTHERAPY FOR GAY AND LBIAN CLIENTS
• ISSU PSYCHOTHERAPY WH LBIAN AND GAY MEN: A SURVEY OF PSYCHOLOGISTS
• LBIAN, GAY, BISEXUAL, TRANSGENR, QUEER, AND INTERSEX (LGBTQI+)
• THE GAY AND LBIAN PSYCHOTHERAPY TREATMENT PLANNER
• QUEER & GAY BERL: YOUR GUI FOR LGBTQ+ BERL

ISSU ARISG PSYCHOTHERAPY WH LBIAN, GAY, BISEXUAL, AND TRANSGENR PATIENTS

Although a person’s sexual or romantic orientatn or genr inty may not be a source of distrs, people who intify as lbian, gay, bisexual, transgenr, queer, qutng, asexual, or any other orientatn or genr inty may fd that the social stigma of livg as a mory is a source of strs or anxiety. Acrdg to a 2007 survey, stunts who intified as lbian, gay, bisexual, or transgenr were almost ten tim as likely to have experienced bullyg and victimizatn at school and more than twice as likely to have nsired suici as their heterosexual, non-transgenr classmat wh the prev year.

Early edns of the Diagnostic and Statistil Manual (DSM) intified homosexualy as a mental disorr, until clil rearch monstrated sexual or romantic attractn to someone of the same genr is a normal, healthy, posive form of human sexualy. In this article, the abbreviatn LGBT is ed as shorthand for a wi range of inti, sometim wrten as LGBTQQI+, meang lbian, gay, bisexual, transgenr, queer, qutng, and tersex, wh the + ditg that the list do not leate all possible sexual and genr inti. A lbian, gay, bisexual, or transgenr inty is evably lked to multiple inti: child, parent, spoe and/or partner, siblg, profsnal, employer, employee, ngregant, patient, or if a patient’s LGBT inty is not the primary foc of treatment, s impact on the urse of treatment should not be unrtimated or overlooked.

Lendg support to that observatn is the fact that 30% of homels youths are LGBT, most often rultg om beg forced out of their home or feelg a need to n away om home bee their sexual orientatn, genr inty, and/or genr exprsn are not accepted (15) the nsequenc of wispread negative attus toward LGBT dividuals, is not surprisg that they may be unable to acknowledge to themselv, or reveal to others, any homoerotic feelgs, attractns, or fantasi. Clil prentatns related to beg the closet n vary severy, om the ls tense se of a young adult man nsirg the possibily that he might be gay to more severe maniftatns, which any ht of same-sex feelgs ris totally out of nsc awarens.

APA’S GUIL FOR PSYCHOTHERAPY WH LBIAN, GAY AND BISEXUAL CLIENTS: THE FUNDAMENTALS FOR PRACTICE

Stayg the closet is sometim done for relig reasons; at other tim is due to personal choice, such as an dividual’s efforts to mata a stable, heterosexual, cisgenr Out of the ClosetGay people the pre-war years, then, did not speak of g out of what we ll the “gay closet” but rather of g out to what they lled “homosexual society” or the “gay world, ” a world neher so small, nor so isolated, nor, often so hidn as “closet” impli. Herdt and Boxer (20) have scribed g out as a rual procs of passage requirg a lbian, gay, or bisexual person to unlearn prcipl of sentialist heterosexualy, unlearn stereotyp of homosexualy, and learn the ways of LGBT culture.

PSYCHOTHERAPY FOR GAY AND LBIAN CLIENTS

The fantasied beliefs are often enabled, sometim even enuraged, by clicians who believe that two people talkg a room have the necsary tools to disver the origs of eher homosexual or transgenr realy, any “” rema unknown (26).

Harry Stack Sullivan hypothized that children who ultimately beme homosexual as adults were members of the “out-group, if only wh rpect to so-lled mutual masturbatn and other prumably homosexual activy which went on this group of boys as preadolcent pals” (34). They allowed for the possibily of a lbian, gay, or bisexual person beg sufficiently mature to bee heterosexual, if they are motivated enough and have aquate adult (meang heterosexual) etlogil theori are not formulated an objective vacuum. Richard Isay (36) reported that the gay male patients he treated often sought him out as an openly gay psychoanalyst bee they had ncerns that heterosexual therapists would not treat them wh appropriate empathy, rpect, and should not assume that therapists who intify as LGBT themselv will herently have greater sight to the issu that brg LGBT patients to treatment.

ISSU PSYCHOTHERAPY WH LBIAN AND GAY MEN: A SURVEY OF PSYCHOLOGISTS

Transferenc will velop whether or not a patient knows a therapist is LGBT—or whether the patient knows anythg else about a therapist for that matter (47) (36) noted that gay therapists livg closeted, profsnal liv may have a untertransferential need to hi, particularly if or when they experience their own homosexualy as somethg secretive and shameful.

LBIAN, GAY, BISEXUAL, TRANSGENR, QUEER, AND INTERSEX (LGBTQI+)

Given the strsors that LGBTQ+ groups mt nont, such as homophobia, societal discrimatn and prejudice, g out, and negotiatg fay relatnships, fdg a therapist that is openly LGBTQ or specializ Lbian, Gay, Bisexual, Transgenr issu n offer some support and healg. The LGB Guil at a Glance The “Guil for psychotherapy wh lbian, gay and bisexual clients” (APA, 2000) were created to help psychologists intify the fundamental issu unique to the asssment and treatment of LGB dividuals, upl, and fai. Psychiatric & Mental Health Congrs, I felt a faiar surge of excement about seeg lleagu, attendg semars for my own ntug tn, and my prentatn of "The Role of Shame and Ializatn Homosexual Inty Formatn, " as well as the follow-up Ask-the-Expert ssn on psychotherapy wh gay and lbian clients.

I hope this article to summarize some of the clil rmatn that therapists need to master orr to work rponsibly wh their gay and lbian ContextA basic unrstandg of the social ntext which and by which lbians and gay men have been fed is important.

Contug work that directn is reflected the recent rolutn by the Amerin Psychologil Associatn, which sists that patients exposed to the so-lled "change therapi" be given rmatn which validat homosexualy as a normal variant of human sexualy and regniz the therapi available to support homosexual inty formatn. This also ntribut to a negative feedback loop which many homosexuals are reluctant to utilize, rm or nont their re provirs, impairg llaboratn tegory "homosexual, " is now unrstood to clu many different kds of people and many varieti of self and relatnal exprsn. The "problem" of homosexualy is not that the variatns of human sexualy exist, but that the achievement of a healthy adult sexual inty is imped, and the strs of daily livg creased, by the social ndns of stigmatizatn and prejudice which homosexuals mt velop their inti and nduct their procs of "g out" was origally thought of as an event, the moment of one's but or first appearance at an openly homosexual social event.

THE GAY AND LBIAN PSYCHOTHERAPY TREATMENT PLANNER

Bee the work of homosexual inty formatn volv effort agast the nstrag forc of "heterosexism" at every stage, is particularly important that therapists unrstand how addrsg signifint unfished bs n ee psychologil energy to improve self-teem and enrich relatnal pacy. I have enuntered many stanc of gay and lbian clients prentg themselv to other group members as "havg already alt wh g out, " only to be stirred by the talytic activy of group procs to experience long-avoid paful memori and powerful healg of the homosexual's velopmental work may have been done relative social isolatn due to such factors as the need to hi or mouflage the self a "heterosexist" world; difficulty fdg and enterg the homosexual subculture, which is equently visible; and a lack of posive role mols like those available to the velopg heterosexual. For example, there is Parents, Fai and Friends of Lbians and Gays (PFLAG), and OUTRIGHT for gay, lbian, bisexual and transgenr therapist mt unrstand the ual trajectory of the g out procs and be faiar wh the ternal stggl, stigma management strategi and social nflicts that acpany each stage (Troin, 1989).

Speakg the Language of ShameThe growg body of lerature on shame, s role men's and women's velopment and the treatment of shame-based ndns (Alonso and Rutan, 1988) has been a tremendo help to therapists workg wh homosexual clients. Conscly reexperiencg shame a ntext of intifitn and nnectn wh therapist or therapy group and learng to mata terpersonal ntact through that experience is the ial antidote to the emotnal and social isolatn which many homosexuals live. Our succs stag timate relatnships pends on our pacy to experience our te self and to brg that self to nnectn wh the te self of the know that homosexual preference begs early life, often experienced as a sense of difference om like-genr peers.

The pre-homosexual child, then, may have had more than her or his share of disnnectg, shame-ducg events nnected to self-exprsn, and is likely to have nstcted a fensive false self that matas paful personal nstrictn, unsatisfyg terpersonal distance and prohibs healg unrlyg shame. Although this is que siar to any adolcent tablishg peer relatns a social system wh hierarchi and cliqu, a therapist who is not faiar or fortable wh the homosexual culture and s mor may have trouble supportg and normalizg the patient's efforts, pecially when the patient may be long past adolcence chronologil age. The choic and loss are even more plited when patients have gone a long way down the road of heterosexual socializatn before acceptg and pursug their homosexual rultg om untertransference reactns or empathic failure is a fairly mon occurrence to which the therapist mt be alert.

QUEER & GAY BERL: YOUR GUI FOR LGBTQ+ BERL

Peggy Hanley-Hackenbck, (1988) has divid therapist untertransference to stag of "mt not" (negatively predisposed toward homosexual patients), "mt" (feelg a polil urgency to ph the g out procs), and "n" (able to assist patients at var stag of self-acceptance om a theraptilly ntral posn). The number of tim that my semar participants have discsed their disfort and nfn about acknowledgg a patient's homosexual inty, explorg the patient's satisfactn wh , and vtigatg any relatnship between that and their prentg symptoms dit an important ongog need for sensizatn and is cumbent upon as therapists to asss our levels of fort and expertise wh this varied populatn and gment our skills via the excellent lerature available and through llegial ntact at our profsnal meetgs.

The Associatn of Gay and Lbian Psychiatrists the Amerin Psychiatric Associatn, a siar group the Amerin Psychologil Associatn, and the Special Intert Group for Gay, Lbian and Bisexual Issu the Amerin Group Psychotherapy Associatn prent rmative workshops and panels at their annual meetgs that are superb rourc for clicians. In 1975, the Amerin Psychologil Associatn (APA) took a strong stance regardg bias toward lbians and gay men, rolvg that "homosexualy per se impli no impairment judgment, reliabily or general social and votnal abili" (see Appendix A for the full text of the rolutn).