Upon hearing multicultural counseling, culturally diverse counseling, or counseling of diverse populations most people may think of groups that differ from the dominant culture in our society, such as, race, culture, ethnicity, etc. Many people do not think beyond these categories to consider a second tier of diversity, for instance, age, disability, sexual orientation, etc. What is the dominant culture? In most references the comparison is associated with the White Euro-American norms. The basic assumption that heterosexuality is the only normal path of all human beings creates a need for counseling trainees to consider the hidden minority group of gay, lesbian, bisexual, and transgender issues (GLBT).
In general, many counselor trainees might be unfamiliar with the distinction of these above-mentioned titles. An affection and/or orientation to a person of the same sex is referred to as homosexuality (Sue and Sue, 2003). Commonly, males are known as gay, females are known as lesbians. Individuals who self-identify themselves as homosexual or as heterosexual and move back and forth between the groups are self labeled as bisexuals (Matthews, 2001). Transgender individuals consist of transsexuals, individuals undergoing hormone treatment, and others who elect surgery (Sue and Sue, 2003). In most of my readings and research on counseling diverse populations, I find that bisexual and transgender issues have been omitted or lightly touched upon.
Among the gay subculture there is a difference between gay and homosexual. Homosexual has a negative connotation because it has been used as a diagnostic label by many clinicians, concerns only to sexual orientation, and is frequently accompanied by a negative self-image. The word gay has come to indicate an attitude of positive self-acceptance, which includes affection, emotions, life-style, and political perspective as well as sexual orientation (Beane, 1981).
Sexual orientation can simply become an invisible diversity in the way that differences of gender, race, or disability cannot. Counselors need to be attentive to the possibility of this difference of ‘vanishing’ within the therapy. Counselors must be confident of talking with clients about sexual orientation (Mair and Izzard, 2001).
Everyone feels different growing up, however the experience of the gay person is unique. As African Americans (or any racial minority group) children grow up, they see and interact with other African American children and their families are mostly from the same minority group. This is not the same with gays who grow up in an environment that seems to be totally heterosexual (Beane, 1981).
As with other minority groups in the United States, GLBT individuals are shamed for their minority group class. For instance, gay men and lesbians are the victims of more hate crimes than any other ethnic or non-ethnic minority group in the United States (Barrett and McWhirter, 2002). GLBT individuals encounter types of oppression and discrimination comparable to those experienced by people of color (Carroll, 2001). When GLBT clients begin therapy they may also encounter the same disapproval, stigmatization, and other obstacles of social equality.
The idea that homosexuality was a perversion seems to have dominated the work of analysts until the 1970s. The American Psychological Association accepted an official policy that stated,
“Homosexuality per se implies no impairment in judgment, stability, reliability, or general social or vocational capabilities.”
Furthermore, they specified that mental health professionals should take the lead in eliminating the stigma of mental illness long associated with homosexual orientations (Sue and Sue, 2003).
In 1991, the Committee on Lesbian and Gay Concerns of the American Psychological Association discovered that 58.2 per cent of therapist stated knowing personally about events of professional bias against GLBT clients. This led researchers to assume that “bias and misinformation persist among some psychologist” (Carroll, 2001). Homophobia defined is the fear of homosexuality and homosexuals (Beane, 1981). The GLBT community views individuals exhibiting these behaviors as homophobic.
Within families, homophobia can appear in the forms of verbal abuse, physical threats, or physical attack. In a survey of GLBT teens in Rhode Island, 58 per cent of GLBT females reported experiencing these three types of victimization committed by their mothers, 34 per cent by their fathers, 24 per cent by their brothers, and 15 per cent by their sisters. In the same survey, GLBT males accounted 30 per cent victimization by their mothers, 23 per cent by their fathers, 43 per cent by brothers, and 15 per cent by their sisters. The most significant predictors identified as a risk factor of GLBT teen suicide is negative family interactions (Quinn, 2002).
Nearly 26 per cent of GLBT youth are forced to leave their homes due to disputes concerning sexual orientation. This leaves the youth feeling isolated and unaccepted by the family. Often, teens believe running away is the only option. It makes teens feel like they have some control of their situation (Quinn, 2002). If GLBT teens seek refuge in a shelter will they meet the same discrimination and rejection they initially were trying to escape? Counselors at shelters need to be prepared to protect, and not perpetuate, these GLBT teens from further victimization.
Social groups, tremendously have an impact during the teenage years, GLBT teens may miss out on these experiences due to homophobic attitudes. The teenage years are a major time for development of “gender intensification,” the “strong intolerance of cross-sex mannerisms.” Homosexuality, bisexuality, and transgender concerns can be considered as abnormal, especially during this stage of development. The cultural norm of heterocentricity gives GLBT teens reasons to hide their identity to fit into peer group expectations. Dominant culture norms dictate that to be a part of the GLBT community is not to belong at all. This validates the GLBT teen’s trouble in deciding his or her identity by coming out. Revealing such information to peers has serious shaming effects (Quinn, 2002).
In a study by Marsiglio in 1993 that measured the attitudes of 15 to 19 year old heterosexual males concerning homosexuality and having gays as friends maintain the reasons why GLBT teens choose not to come out. Virtually 89 per cent of the adolescent males surveyed said sexual activity between two men to be disgusting, and 59 per cent stated that they could not be friends with a gay person. Related to these findings is the topic of gender role expectations and negative labeling amongst male peers. Examples of the “macho” mentality include negativity around men who seem feminine, the adoption of masculine mannerisms, and dress. Males who do not fit into the “macho” roles are frequently labeled as gay, which confirms the correlation this mentality has with homophobic attitudes, as being gay is considered negative (Quinn, 2002).
Associated to the homophobic attitudes of peers is the homophobia that GLBT teens encounter in school. Most schools do not integrate sexual orientation and gender identity education into their curriculum. This deficiency in education is a major setback for GLBT youth, allowing the justification of homophobic attitudes and the internalization of these attitudes by GLBT teens. The silence around these subjects illustrates the message that something is wrong with GLBT teens. Fear, shame and guilt are usual responses to this message. Also, they feel estranged because no system within schools validates these teens. When a person is not validated, he or she does not feel safe within their true identities (Quinn, 2002).
The educational system belongs to the larger societal system that considers GLBT people as deviant. In a study by Willis and Crawford in 2000 on attitudes about homosexuality offers insight into the current attitudes of homophobia existing within the social environment that is continually surrounding GLBT teens. Of respondents, 81 per cent stated that gay marriages should not be legalized, 58 per cent said that gays should not be hired as teachers (Quinn, 2002).
It appears that in America’s cultural context, homophobia causes discrimination and stigmatization of GLBT people. Not allowing openly gay people to serve in the military is an example. Concealed examples are also present in everyday life. For instance, gay people are typically not eligible for their partner’s family health care. Applications that contain a marital status checklist (divorced, married, single, widowed) do not imply that partnerships between GLBT individuals also exist. Religious beliefs within many groups include the trivialization of GLBT people. In the study by Marsiglio, he found that adolescent male respondents were more likely to have homophobic attitudes in positive relation to their participation in religious fundamentalist groups. These issues greatly affect GLBT teens’ views of themselves, and influence internalized homophobia (Quinn, 2002).
Coming to self-identity as a gay man or woman, followed by disclosure of this identity to friends and family, is known as coming out (Galatzer-Levy and Cohler, 2002). GLBT adolescents are coming out at younger ages, which raise significant questions about how to best guarantee their health and happiness. Especially, since facts suggests that early self-identification is associated with greater morbidity (Elze, 2002).
Being able to tell a coherent life story and to share this story with others significantly adds to a sense of personal integrity and coherence. Individuals feel less coherent and whole to the point they feel forced to dissemble, especially in vital relationships such as those with parents and other family members. Disputed sexual identities, such as being gay or lesbian, create particular problems for the organization of a sense of coherence (Galatzer-Levy and Cohler, 2002).
Dominant culture differentiates between an inner, private self and an outer, public self. Discrepancies between these two aspects of oneself contribute to shame and lowered self-regard, which may be felt as reduced morale or even depletion. Feeling different in an central way and not living up to presumed family and community expectations often leads to problems in handling personal coherence and a resulting need to deny this difference. Acceptance of alternative forms of desire, first for oneself, and then from family, friends, and the community, can provide an improved sense of personal integrity. Coming out often promotes personal coherence (Galatzer-Levy and Cohler, 2002).
80 per cent of activist gay teens have disclosed their gay or lesbian sexual identity to their parents, less than a fifth of gay or lesbian college students questioned had made a similar disclosure. Among young adults disclosing their sexual orientation, most tell a friend first and then a family member, most frequently their mother. Some studies propose that gay or lesbian youth are more likely to disclose their sexual orientation to brothers and sisters before disclosing to parents, presuming that as members of the same generation they will be most able to understand and support them. But, when siblings are told, it is frequently after coming-out to friends. Clearly, once learning of gay identity, more than three-fourths of siblings are supportive of this decision (Galatzer-Levy and Cohler, 2002).
Psychologists often provide biased, inadequate, or inappropriate treatment for gay GLBT individuals when they wanted services (Barrett and McWhirter, 2002). 34 per cent of psychology graduates reported the availability of any diversity course during their graduate training. Generally, counseling students held positive attitudes toward ethnic minorities and rather negative attitudes toward GLBT individuals. It is intolerable for counselor trainees to harbor biases against racial-ethnic groups. In contrast, when trainees expressed discomfort working with GLBT issues, it was somehow more acceptable. The choice to refer was the ethical one, and the issue was dropped (Carroll, 2001). If counseling trainees are reluctant to confront biases surrounding GLBT issues, how can we expect our society as a whole to become more open and accepting?
In general, GLBT individuals feel there is a sense that sex or sexual orientation was too highly charged an area to talk about with the therapist. Although this might be seen mostly as an issue of transference, it is important to give thought to the fact that homophobia affects client/therapist relationships in a subtle but profound way (Mair and Izzard, 2001). Do therapist wait for clients to speak about their sexuality, to signal that this is an area they wished to investigate, or did the client need the therapist to take up what was unspoken, therefore making it safe to be explored? Most studies indicate that stating one’s thinking about and theoretical stance towards homosexuality very early on in any work with GBLT clients will facilitate the therapeutic process.
If the client encounters silencing, he is not exploring sexual issues; if exploring the issues, he cannot be silenced. These possibilities give rise to what can be viewed as two opposing approaches to therapeutic work with GLBT clients, therapeutic neutrality or gay affirmation. Gay affirmation can be interpreted in two ways, “the therapists being comfortable with their own homosexual feelings, having the explicit agenda of raising experience of oppression to consciousness, deprogramming and undoing negative conditioning associated with negative stereotypes of lesbians and gay men, or a non-discriminatory, contextually aware attitude that can be incorporated into mainstream psychotherapy theory and practice.” Therapeutic neutrality is about non-judgmental curiosity, the freedom to enquire into any and every aspect of the client’s life, without prejudice, bias or a wish to condemn (Mair and Izzard, 2001).
Investigations of GLBT populations in the 1980s seemed to indirectly support the idea that they would prefer to work with therapists who are also gay. More recent investigation of counselor preference is not as clear-cut. Modrcin and Wyers discovered that gender, not sexual orientation, differed between GLBT individuals in selecting therapists (Kaufman and Carlozzi, 1997).
When a GLBT individual comes out this often represents an important shift in one’s worldview. They move away from a heterosexual identity. This can be similar to a translocation similar to that encountered by ethnic minorities when moving to a significantly new area. The GLBT person’s mental health and functioning can be affected. The Ethnocultural Assessment has been adapted to be used with gay and lesbian clients. This is known as the Sexual Orientation Enculturation Assessment (SOEA), it is intended to provide counselors with a way of understanding the extent to which gay and lesbian clients experience and incorporate their sexual orientation into their lives (Matthews, 2001).
SOEA is less sequential than the Ethnocultural Assessment; SOEA uses dimensions instead of stages. It is not necessary to stick closely to the order of the dimensions of the SOEA but to use the assessment when appropriate, for instance at different times of client contact. The five dimensions are: family culture, client’s internal process, coming out, involvement in the gay and lesbian community, counselor self-assessment (Matthews, 2001).
The Sexual Identity Formation (SIF) Model is used in group therapy for GLBT individuals. In this model a gay male led the group with a heterosexual female as a co-facilitator. The group met once a week for one and half hours over the course of 18 weeks. Group members attended a half-hour screening before entering the group. During the screening, the possible members describe his/her concerns and issues, and the therapists explain the nature of the group, as support-therapy. Also during the screenings, counselors discuss their sexual orientation with the possible participants (Chojanacki and Gelberg, 2001).
The SIF proposes six stages of identity development, confusion, comparison, tolerance, acceptance, pride, and synthesis.
Stage and NameWorldviewBrief Description
Identity Confusionheterosexualbeginning internal awareness of thoughts, feelings, or behavior
Identity Comparisonheterosexualincrease contact with GLBT persons
Indentity Toleranceheterosexualincrease in GLBT contact, selective openness about sexual orientation, extremely limited disclosure
Identity Acceptancetransitionalmore positive view of the GLBT self increased networking
Identity PrideGLBTstrong GLBT identity, confrontation with heterosexuals
Identity Synthesisintegrativesexual orientation as part of total identity, allows both positive and negative perceptions of GLBT and heterosexual persons
Therapist who want to work with gay clients need to be aware of his or her stereotypes and prejudices. It is the therapist’s responsibility to inform the highly homophobic client that the myths and stereotypes are not representative of most gay individuals. Therapists need to be aware of where the gay client can find other gay people who feel good about themselves.
Barrett, K., & McWhirter, B. (2002). Counselor Trainees’ Perceptions of Clients Based on Client Sexual Orientation. Counselor Education & Supervision, 41, 219-232.
Beane, J. (1981). I’d Rather Be Dead Than Gay”: Counseling Gay Men Who AreComing Out. The Personnel and Guidance Journal, pp. 222-226.
Carroll, L. (2001). Teaching ‘Outside the Box’: Incorporating Queer Theory in CounselorEducation. Journal of Humanistic Counseling, 40.
Chojnacki, J., & Gelberg, S. (1995). The Facilitation of Gay/Lesbian/Bisexual SupportTherapy Group by Heterosexual Counselors. Journal of Counseling &Development, 73, 352-354.
Elze, D. (2002). Risk Factors for Internalizing and Externalizing Problems
Among, Gay,Lesbian, and Bisexual Adolescents. Social Work Research, 26, 89-100.
Galatzer-Levy, R., & Cohler, B. (2002). Making a Gay Identity: Coming Out, SocialContext, and Psychodynamics. Annual of Psychoanalysis, 30, 255-286.
Kaufman, J., & Carlozzi, A. (1997). Factors Influencing Therapist Selections AmongGays, Lesbians and Bisexuals. Counseling Psychology Quarterly, 10, 287.
Mair, D., & Izzard, S. (2001). Grasping the nettle: gay men’s experiences in therapy.Psychodynamic Counseling, 475-490.
Matthews, C. (2001). Adapting the ethnocultural assessment to gay and lesbian clients:the sexual orientation. Psychology and Behavioral Sciences Collection, 40.
Sue, D.W., & Sue, D. (2003). Counseling the Culturally Diverse: Theory and Practice(4th ed.).