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The following article is designed to provide insight into some of the concerns and issues which might come up when counseling someone who identifies with a minority sexual orientation. It is important to remember when reading this article, that these are generalized points of information. It is a starting point to help you understand how LGBTQ clients might be different from clients from the majority culture. It is vital to assess the level of acculturation or biculturalism of each and every person.

First off, LGBT2IKQ2IK individuals have a creative vocabulary on the subject of sexual orientation because they may often use code words for safety reasons. You see similar behaviors in people who are alcoholic for example when they ask eachother “Are you a friend of Bill?” Code phrases help them identify who is open and safe to be themselves around. However, even if you have an open rerlationship with someone who is LGBT2IKQ2IK doesn't mean they approve or appreciate terms which you may think are acceptable. It is important to ask. For example the term “homosexual” overemphasizes sexuality and seems to indicate that the sex act is more important to homosexuals than it is to heterosexuals. It also resurrects memories of when homosexuality was considered a psychiatric disorder. Hence, the words “homo,” “bi,” “queer,” or “gay” are preferred by some LGBT2IK persons. Likewise, some LGBT2IK persons are offended by the term “queer.” Some lesbians may prefer to be called dyke or gay, instead of lesbian. When talking to someone who is transgender it is important to call a the persoon by his or her preferred name and always to use the gender designation that the client has chosen.


Nonverbal messages also communicate a lot about safety and acceptance. LGBT2IK individuals rely tremendously on nonverbal cues to establish whether the situation is safe for them to be themselves. Evidence that they are accepted and welcome include: A rainbow-colored flag, “Straight But Not Narrow” bumper sticker, A mission statement that includes a commitment to honoring diversity or a commitment to treating LGBT2IK clients, the presence of gay or lesbian staff members, and materials used in treatment that acknowledge the LGBT2IK experience.

But what unique issues might someone who is LGBT2IKQ2IK present with? In contrast to how members of ethnic cultures are marginalized, LGBT2IK individuals may receive disapproval and censure from those whom they most trust and rely on—parents, relatives, religious leaders, teachers, and friends. Most members of ethnic minorities can escape discrimination by returning to a supportive family or neighborhood. This is not always true for LGBT2IK persons. Additionally, when they are growing up, their positive role models are not easy to identify, although this is rapidly changing in 2018.

Another unique issue is that the LGBT2IK culture is one that is not developed, taught, or transmitted by families, so persons have to figure it out along the way. One of the issues of debate in the LGBT2IKQ2IK community is whether to highlight similarities or transform mainstream society. Because public acceptance is important, many LGBT2IK persons want to advance the message that LGBT2IK individuals are no different from non-LGBT2IK persons. Some worry that highlighting the similarities and the positive aspects of gay culture will mean the loss of that culture as the LGBT2IK community is accepted into mainstream culture. Others believe that the gay community should try to transform mainstream society rather than join it. This leaves a person developing their identity to struggle to find which “camp” they fit in. Additionally, there is debate over how to be gay. Some believe there is one right way which may lead not honoring LGBT2IKQ2IK persons with other lifestyles or opposing views. One example for bisexuals is that some lesbians and gay men do not accept bisexuality as a legitimate sexual orientation but regard it as a developmental phase on the way to acceptance of a lesbian or gay identity. Similar issues also arise for persons who are asexual or pansexual.

In addition to understanding a client’s ethnic background, counselors should keep in mind how the client’s culture views LGBT2IK individuals and the effect this viewpoint has on the client. Each ethnic minority group has norms and values about LGBT2IK members and behavior. LGBT2IK persons of color cope with trying to fit into the gay, lesbian or kink communities in the face of racism and discrimination. For some, the added burden of these issues makes finding a comfortable place in society even more complex and difficult.

Protective factors in one setting can compensate for risks in multiple settings. Secure attachment during the coming out process functions to enhance coping with antigay prejudice, self-acceptance, and self-esteem. Family support and acceptance explains adolescent comfort and resilience in later life. Early and continuous attachment positively shapes relationship development in later years among all young children, adolescents, and adults, and a moderately internal locus of control facilitates self-efficacy.

Studies of resilience for youth who are a sexual/gender minority have demonstrated that positive social relationships moderate the relationship between stress and distress, and affirming faith experiences contribute to less internalized homonegativity, more spirituality, and psychological health. Did you know that the Episcopal church approves ordination of transgender people, and in 2010 150 Orthodox rabbis and educators signed a declaration calling for the welcoming of LGBTQ2IK Jews in the Orthodox community

Many clients will come to counseling during different stages of coming out. Understanding this process, and the fact that not everyone chooses to “come out” is a vital issue for clinicians. The term “coming out” refers to the experiences of lesbians and gay men as they work through and accept a stigmatized identity, transforming a negative self-identity into a positive one. There is no correct process or single way to come out. For those LGBT2IK persons who do not come out, it is important to help them develop a positive identity of their choosing.

The CASS Model describes the coming out process. Note that the defenses in each stage somewhat parallel the grief process.

Stage I: Identity Confusion
Occurs when a person begins to realize that he/she may relate to or identify as being LGBT2IK, a process of personalizing the identity.
Tasks: Exploration and increasing awareness
Feelings: Anxiety, confusion
Defenses: Denial

Stage 2: Occurs when a person accepts the possibility the he/she might be LGBT2IK
Tasks: Exploration of implications, encountering others like oneself
Feelings: Anxiety, excitement
Defenses: Bargaining and rationalizing

Stage III: Identity Tolerance
Occurs when a person comes to accept the probability that he/she is an LGBT2IK person.
~ Tasks: Recognizing social and emotional needs as a LGBT2IK person
~ Feelings: Anger, excitement
~ Defenses: Reactivity

Stage IV: Identity Acceptance
Occurs when a person fully accepts rather than tolerates himself or herself as an LGBT2IK person.
~ Tasks: Development of community and acculturation
~ Feelings: Rage and sadness
~ Defenses: Hostility towards straight culture

Stage V: Identity Pride
Occurs when the person immerses himself or herself in the LGBT2IK community and culture to live out identity totally
Tasks: Full experience of being an LGBT2IK person, confronting internalized homophobia
Feelings: Excitement and focused anger
Defenses: Intense pride and rejection of straight culture as the norm

Stage VI: Identity Synthesis
Occurs when a person develops a fully internalized and integrated LGBT2IK identity and experiences himself or herself as whole when interacting with everyone across all environments.
Tasks: Coming out as fully as possible, intimate gay and lesbian relationship; self-actualization as a LGBT2IKQ2IK person,
Feelings: Excitement and happiness
Defenses: Minimal

During the coming out process, or even deciding whether or not to come out, people often struggle with issues of shame. Neisen's 3-Phase Model for Recovery From Shame explores this process.
Phase 1: Breaking the Silence parallels the process of coming out. It is important for LGBT2IK individuals to tell their stories and to address the pain of being different in a heterosexist society.
Counselor Tasks:
• Facilitate client discussion of hiding LGBT2IK feelings from others
• Explore emotional costs of hiding/denying one's sexuality
• Discuss how the client has tried to fit in and at what cost
• Examine negative feelings of self-blame, feeling bad or sick, and the effect of shaming messages on client
• Foster client's ability to be out

Phase Two: Establishing Perpetrator Responsibility
Phase 2: Allows clients to understand their struggle in the context of societal discrimination and prejudice.

Counselor Tasks:
• Facilitate focusing and, managing anger constructively, not destructively
• Help client understand and accept negative self-image as socio cultural, not personal
• Counteract client's experience of heterosexism and homophobia by role-modeling and by providing a treatment environment that is empowering for LGBT2IK persons, not stigmatizing.
Phase Three: Reclaiming Personal Power

Phase 3: Involves improving self-concept, self-esteem, and self-confidence
Counselor Tasks:
Facilitate client's self-concept and self-efficacy
Identify and change negative messages to affirmations
Recognize and release residual shame
Develop a positive affirming spirituality
Integrate public and private identities
Build a support network, connect to community

Other Treatment Issues
One third of suicide first attempts (of LGBT youth) occurred within the same year of self-identification as gay or bisexual.

Counselors need an understanding of the dynamics of LGBT2IK interpersonal relationships including the internal and external problems of same-sex couples and the diversity and variety of relationships in the community. Although many individuals have a life partner, others are single or in nontraditional arrangements outside the cultural norm of a heterosexual, monogamous, and legally sanctioned marriage. Many LGBT2IK individuals are also parents and have children from a heterosexual marriage, adopted children, or have children through other means. Parenting issues and helping children deal with oppression may be issues to address.

For transgendered persons hormone therapy is an often overlooked issue. Hormone therapies can affect mood, especially when taken improperly. Transgender clients may face an additional risk from using “street” or “black market” hormones. Because testosterone must be injected, obtaining or using needles may be relapse triggers for clients in early recovery from IV drug use. This can also increase the risk for transmission of blood borne diseases due to sharing needles.'

One group formed to advocate for children who are discovering a minority sexual orientation is the Family Acceptance Project (FAP). FAP was designed because there is a clear link between family rejecting reactions to sexual orientation and gender expression during adolescence and negative health and mental health outcomes in LGB young adults. FAP Recognizes that parents and caregivers who are seen as rejecting their LGBT2IK child are motivated by care and concern to help their child “fit in,” have a “good life,” and be accepted by others. They also understand that family behaviors are not isolated incidents, but occur in a cultural context aimed at socializing their children and adolescents to adapt and be successful in a hetero-normative (heterosexual) society. These family behaviors aim to protect their children from harm, including victimization due to their LGBT2IK identity and gender expression.

Research findings are used to link reactions to their child’s LGBT2IK identity with health, mental health, and wellbeing. Beyond building a strong alliance between families and providers, family awareness of the consequences of their behavioral reactions is the most important mechanism of change Understands that parents and families experience their lack of knowledge about LGBT2IK issues as inadequacy that feels disempowering and shameful. Many families perceive their children’s LGBT2IK identity as a loss, particularly as a loss of control over their children’s future.
Providers should help families validate and address these feelings by affirming the importance of family support to build their child’s self-esteem, to promote their child’s well-being, and to buffer rejection and negative reactions from others.

In conclusion, when working with LGBT2IK clients and families, demonstrate support and understanding for the client, the spouse, life partners, significant others. Remember that no universal terminology exists regarding significant others in the LGBT2IK community, and be careful of biases regarding what a family should be.

It is vital to meet clients where they are in the coming out process and respect their need to feel safe. The best way to do this is to be guided by your LGBT2IK clients, listen to what they say is comfortable for them, advocate and create safety for LGBT2IK clients, support and encourage positive images of LGBT2IK, develop a diversity preparedness plan for working with LGBT2IK community, and work with the community to understand their particular needs and concerns.

~ PFLAG (Parents, Families and Friends of Lesbians and Gays) membership of over 200,000
~ Eshel is dedicated to the work of supporting Orthodox LGBT2IKQ Jewish individuals in their desire to live fully in their religious and cultural traditions.
~ National LGBT2IK Health Education Center
~ SAMHSA A Provider’s Introduction to Treatment for LGBT2IK Individuals
~ A Guide for Understanding, Supporting, and Affirming LGBT2IKQI2-S Children, Youth, and Families
~ Asset-Based Approaches for Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex, and Two-Spirit (LGBT2IKQI2-S) Youth and Families in Systems of Care
-The Asexual Visibility and Support Network

Objectives for the video course
Learn terminology specific to the LGBT2IKQ2IK community
Explore specific verbal and nonverbal communication issues
Learn the stages of the coming out process
Review Neisen's 3-Phase Model for Recovery From Shame and counselor tasks
Identify LGBT2IKQ2IK Cultural Issues
Identify how race, culture and ethnicity impact identity development and acculturation
Identify specific treatment issues which may be unique to this population
Learn about the Family Acceptance Project

~ Sex: Genetic and anatomical characteristics with which people are born
~ Intersex: Some individuals are born with a reproductive/sexual anatomy that does not fit typical definitions of male or female. Not all of these individuals identify as intersex.
~ Sexual orientation: A person’s emotional, sexual, and/or relational attraction to others including heterosexual, gay/lesbian, bisexual
~ Gender identity: Our internal sense of being male, female Because gender identity is internal, it is not necessarily visible to others.
~ “transgender” describes people whose gender identity/expression is different from that typically associated with their assigned sex at birth. gender identity, in many cases, is independent of sexual orientation
~ A transgender person “transitions” to express gender identity through various changes including wearing clothes and adopting a physical appearance that aligns with their internal sense of gender.

~ Gender expression: The manner in which people represent their gender to others individual through mannerisms, clothes, and personal interests.
~ Two-Spirit: An inclusive term created specifically by and for Native American communities. It refers to American Indian/Alaskan Native American people who (a) express their gender, sexual orientation, and/or sex/gender roles in indigenous, non-Western ways, using tribal terms and concepts, and/or (b) define themselves as LGBT2IKQI in a native context.
~ Heterosexism resembles racism or sexism and denies, ignores, denigrates, or stigmatizes nonheterosexual forms of emotional and affectional expression, sexual behavior, or community.
~ Homophobia is defined as the irrational fear of, aversion to, or discrimination against LGBT2IK behavior or persons.
~ Internalized homophobia describes the self-loathing or resistance to accepting an LGBT2IK sexual orientation and is an important concept in understanding LGBT2IK clients
~ Lesbians are people who identify as female, who are attracted to others who identify as female
~ Gay: means anyone who’s attracted to people of the same sex
~ Bisexuals are attracted to both the male and female sex
~ Transgender born a certain sex but identify as a different gender
~ Queer: a very inclusive term for anyone in the LGBT2IK+ community. Choosing to identify as ‘queer’ can mean individuals don’t have to belong to a more specific category if they aren’t sure of their sexuality/ gender or simply don’t want any other label
~ Intersex: intersex it means they are born a certain gender but their sexual or reproductive anatomy is from the opposite sex
~ Asexual: When a person is asexual it simply means that they aren’t very sexually attracted to either sex and have a generally low level of interest and desire to take part in sexual activities.
~ Pansexual: When someone is pansexual it means they are attracted to people regardless of their gender. They are attracted to individuals rather than one particular gender or sexuality
~ Polygamous/ polyamorous: People who identify as polygamous/ polyamorous have consenting open relationships with more than one person at a time.
~ Kink is about those who have kinky fantasies. This could involve BDSM (Bondage and Discipline, Dominance and Submission, and Sadomasochism); Female Led Relationships, Dom/sub relationships

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