Laura Brackett's specialties are advising LGBTQ + people. A common complaint she hears from her customers is that those outside the LGBTQ + community – including some psychiatrists – consider it a large, happy family that shares the same problems and concerns.
Of course this is not the case. "There can be deep and painful differences between the different groups that make up this community," said Brackett, a member of the American Counseling Association, which practices and leads the community's engagement at Change Inc., St. Louis.
This is particularly true for marginalized communities within the LGBTQ + population. For example, American society has made significant progress in accepting differences in sexual or “affective” identity, but is clearly uncomfortable with alternative gender expressions such as transgender and non-binary, says ACA member Christian Chan, assistant professor in the department for Consulting and educational development at the University of North Carolina Greensboro. People can generally understand (albeit reluctantly in some cases) being gay, lesbian, or bisexual as who they love. However, the idea that someone is assigned the wrong gender at birth or that a person refuses to choose the binary number of a man or woman undermines deep-seated ideas about what constitutes a person's identity, explains Chan, whose research interests are intersectionality and affected topics include strange people with color.
Even the LGBTQ + community tends to prioritize affective identity over gender, says Chan, a member of the Association for Lesbian, Gay, Bisexual, and Transgender Counseling (ALGBTIC), a division of ACA. For too long, there was a hierarchy whose needs matter, he claims, and transgender people – especially women with skin color – were at the bottom.
"Mental health providers don't really culturally respond to the needs of [diverse] communities – especially communities with multiple identities," he says. Even consultants who affirm LGBTQ + customers do not always take the time to consider clients' overlapping identities and the impact of these identities on their mental health needs, Chan adds.
When a transition is not an option
LPC Jessica Jarman Hayes says that the transgender clients she advises are often not outside and almost "sneak into therapy". Hayes, whose Columbia, South Carolina practice specializes in LGBTQ + issues, explains that transgender people are simply not accepted anywhere in the area. If someone in the communities where their customers live found out that these people were struggling with their true identity as transgender women or men, their customers would lose everything, she says. If they were married, their spouses would leave and take their children with them. Their families, friends and neighbors would reject them and not give them any social support. The need for confidentiality is so great that it can be difficult for these customers to even make appointments with Hayes.
Other Hayes customers live in remote areas in the South Carolina lowlands. They can't just get to their office, so their only option is teletherapy, sometimes from a car in a grocery parking lot, because they don't have a safe place at home.
"It reminds me very much of the time when I worked in domestic violence," says Hayes, who also volunteers at the Harriet Hancock LGBT Center in Columbia. "You just have to be there to support them, sometimes for years, when they finally reach a place where [denying their identity] is no longer acceptable and then work out a plan to get out of Dodge."
Violence is a pervasive threat to people who identify themselves as transgender and gender-neutral or “non-binary”. According to the report of the human rights campaign “Violence against the transgender and gender community in 2020”, at least 26 people who were transgender or gender-neutral were murdered in 2019. Most of the victims were African American women.
The report says: "These victims were killed by acquaintances, partners, or strangers, some of whom were arrested and charged while others still need to be identified. Some of these cases have a clear anti-transgender tendency. In other cases, the victim's transgender status may have compromised her in other ways, e.g. B. by forcing them into unemployment, poverty, homelessness and / or survival sex work. "
Hayes says that fear of retribution is another reason, alongside the fear of losing family and friends, that their transgender clients feel in no way able to express their identity. A customer hid underwear in a wall in the house and her spouse bashed her when they discovered her, Hayes says.
In these cases, there is no protection for those who have been abused, since local police do not take such incidents seriously, according to Hayes. This lack of concern is also present when an adolescent is involved, she tells, and tells the story of a suicide hotline call by a transgender teen who was put to flight. The teenager was actively suicidal and in danger. The father had found girl's clothes and hit the teenager hard. Hayes called the police and made it clear that the incident was a domestic violence incident involving child abuse and a victim who had actively committed suicide.
"The police went in there and teamed up with the father," says Hayes. "You said," If you just stopped pretending to be a girl, your father wouldn't have to. "
For a while, the girl was able to keep in touch with Hayes with a self-wiping app on her cell phone in order not to be discovered. Hayes repeatedly called the police, but continued to refuse to take any action. Finally, the father discovered that the girl was making calls and took her phone, computer, and computer out of the house so that she could not answer. Hayes and other volunteers at the Hancock Center did their best to check the teen's wellbeing since losing contact, but were unsuccessful. Your school has been ordered not to provide any information and the local police are not providing assistance. A Columbia police officer has agreed to keep his ears open, but the Hancock Center has heard nothing so far.
Looking for support
Closed transgender women (ie people who present themselves as men at birth according to their assigned gender but secretly identify themselves as women) who are discovered are not only from spouses, but may also be from violence threatened the spouse's family, says Hayes. "This is considered an act of great betrayal."
Hayes advises all Transgender customers to use the time after their phone sessions with them (or any other time they have 15 to 20 minutes of private time) to connect with virtual support groups. She wants customers to find at least one "security buddy" to contact if they just need to speak or if something serious is going on. She also ensures that all customers have the Transgender Peer Support and Crisis Hotline number (Trans Lifeline: 877-565-8860).
Hayes also uses radical acceptance to help their customers deal with the inability to accept their true identity. "OK," she says to customers, "we can radically accept that this situation is really shitty and really uncomfortable, but we have to accept that we are at risk of losing a job or family, even if we never get out , but someone else finds. " out. ”
Hayes asks her transgender clients to always have a bag, but it is challenging to recommend places of refuge. Some shelters for domestic violence in Georgia are affirmative, but they are a significant drive away. There are several homeless shelters in the Columbia region that can accommodate transgender people. However, these are not always good options, as some of them are run by religious organizations that require those seeking refuge to read "applicable" Bible verses. Hayes generally encourages customers to think of relatives they could stay with. Customers don't necessarily have to explain the whole story – just that they have to go, says Hayes.
In an environment where wearing gender-sensitive underwear or painting toenails can be devastating, Hayes admits that it is incredibly difficult to make their customers' lives more livable. Still, she has found some small ways for her transgender and non-binary clients to explore her identity, including playing, an environment where avatars of different or no gender are common.
Another option she suggests – but only if customers believe their phones are protected from control – is the Tumblr social media platform, which is very graphic-oriented and a bit of an intersection between Facebook and Twitter works. Users can set up an account and post or follow others who share art, graphics, GIFs, and other visual content. It is also crucial for Hayes' customers to search for content without registration. Why is this a confirming point of sale? Because Tumblr is a beehive for many types of interests, including fashion, design, decor, and art. Hayes encourages customers to use the platform to find out what their “aesthetics” (personal style) would look like if they were completely free and included not only their looks but also their surroundings.
Hayes began her career as a counselor for domestic violence survivors in the Miami area, where the transgender and LGB affirmations are concerned and violence between gay men or a trans woman and a Cisgender man is taken seriously by the legal system. Although Hayes, who sees herself as a member of the LGBTQA + community, has been in South Carolina for several years, she is still sometimes surprised by the virulence of hatred that many in the region feel about transgender and other queer people. Chan repeats, saying that although different affection orientations are more tolerated (though sometimes reluctant) in some areas, the alternative gender expression is still largely viewed as unacceptable. She believes that there is still significant transphobia within the LGBTQ + community itself, so her transgender clients have very few resources for social support.
family battles
When ACA member Bethany Novotny moved from Pittsburgh to Johnson City, Tennessee to teach as an assistant professor of human services at Eastern Tennessee State University (ETSU), she wasn't sure how friendly her new environment was these would be identification as LGBTQ +. Novotny, who later founded a local lesbian dine-out group, was pleased to note that Johnson City had a robust LGBTQ + community and that it and the university were an oasis among the surrounding Appalachian cities for queer young adults.
Over time, Novotny, an LPC in Pennsylvania, found that students considered her a safe and personable person to talk to. This relationship, her desire to help transgender and non-binary students, and Novotny's friendship with campus counseling staff led her to take over the ETSU transgender support group, now called ASPECTS – support, pride, education, and community for transgender students. The group originally included only students who had been referred by the campus advice center. But Novotny opened it up to all transgender and gender students because she feels that they have unique challenges alongside the rest of the queer community. "People are more afraid [discussing alternative gender expression] than when we talk about sexual orientation," she says.
Novotny oversees while students lead the group that meets once a week. Students share practical information about where to get hormone therapy and where to find positive health care providers. To use these services, you usually need to travel to either Knoxville, Tennessee or Asheville, North Carolina. This is a challenge, especially for students who don't have a car. Novotny says the group often works together to ensure members join when needed.
Not surprisingly, acceptance is an ongoing issue in the group, says Novotny. Students feel safe at ETSU – many for the first time in their lives – but they still have to control family and community attitudes when they go home during breaks.
"We would talk about coping skills [before breaks]," says Novotny. “Sometimes they decided to stay with a friend or other family member. I would remind them to have a contingency plan – to make sure they know what to do when things go bad. “A contingency plan is similar to a suicide security plan with a list of local and campus resources, shelters, and the number of the national suicide hotline.
Once a student who started taking hormones decided that he should come to his family during the break. The group talked it through a few weeks earlier, says Novotny. The student's parents did not take the announcement well and the student was forced to seek protection from a cousin. The cousin was very supportive and even helped the student get to her grandmother, which they would never have thought possible, Novotny says. Too often, however, students returned to school without confirmation from their families.
Although it is particularly difficult to show yourself as a transgender, it is not easy for anyone in the LGBTQ + community to turn to family and friends. Even among families who want to support and reaffirm their loved ones, the process of coming out can be a difficult transition, says Brackett. Some family members – often parents in particular – mourn letting go of the future they had imagined for their loved one, she adds. "This does not mean that they reject the future of their family member as an LGBTQ + person, but only that they may have to adjust the peculiarities of this future. Maybe the vision was of a son who [would have] has a wife and children, and now this vision has to be adapted to [having] a husband instead of a wife, ”says Brackett.
In other cases, families fear that their loved one will become a completely different person, she says. Brackett explains to the families that although changes in expression and personality are very likely, it is not a matter of course that their loved one will experience a complete transformation when they come out.
"Even if there are significant changes, I try to remind families that the person they knew may have been a mask rather than an acceptance," she explains. "This person is now trying to find out who they really are and this process will take some time. It is important to be patient, to be curious, to be respectful and to find [for families to] your own support. "
Novotny says that many of her group members have parents who have difficulties because they perceive the transition in their child's gender expression – from that which the student assigned at birth to their true gender – as a change that they experience Child turned into someone they didn't recognize. This is partly because you don't know what it means to be a transgender.
A student's mother couldn't even understand the concept and said to her child, "You have a penis, so you're a boy," Novotny says. "The student tried to communicate with [their] mother:" I am still the same person. I was this person all the time and you don't see that. I'm trying to share something scary and vulnerable with you. “At the student's request, Novotny helped them speak to their mother.
"I always respond with empathy first," says Novotny. "I know what they are going through [parents] is difficult and I do not want to minimize or reject their feelings. It is about hitting them where they are, although I sometimes want to shake and scream how terrible they are. I have also worked to reaffirm the love and support mom needed to show up in my office that day. The fact that she was there was huge. She was ready to talk even though she was did not understand, and I wanted both my mother and my student to recognize what a big step that was. "
Novotny listened to the mother's concerns and helped correct misinformation by "inserting information that could help mother assemble the pieces of the puzzle. I did it very gently and only where appropriate because I didn't want to jump off as if I were teaching them, ”says Novotny. “As an educator, I know how important it is to plant seeds. We may not always see this come to fruition, but it is so important to gently plant these seeds. … I also try to tell the parents that they don't need to fully understand to offer support, love, affirmation and acceptance. "
In some cases, the family conflict is not based on lack of understanding, but on something more fundamental. Brackett approaches these struggles like Novotny with understanding and empathy.
"I try to understand what your resistance or hostility is about and move away from there," she says. “Working with a family that has deep-seated religious beliefs that condemn sexual or gender minorities is very different from working with a family that is afraid of the changes that can occur in their family system. Sometimes it may be necessary to have these discussions without the LGBTQ + family member, not only to protect them from hearing this process in its harshest form, but also to allow the family room to be open about what they feel . In addition, recommending external support groups or resources can help alleviate some of the misinformation and isolation that the family may be wearing. "
Families also fear the treatment that their loved one might receive in the outside world. "Are they bullied or ignored, or even physically injured or killed?" Brackett says about some of the most common concerns of the family voice. "Will you suffer from mental anguish and be at higher risk of addiction or suicide?"
"It is important for families to remember that the presence of a supportive family is a great protective factor for members of the LGBTQ + community," explains Brackett. “When I work with family members in this place of fear, I try to emphasize the strength they have to create a safe and loving environment for their loved ones. While a mother cannot make the world safe for her sexually ill child, she can at least work to make it safe for her. "
The process of coming out
In some cultures, e.g. For example, those where Hayes' customers live, as well as other racial and ethnic communities, can be dangerous for the LGBTQ + person and possibly for their family. Or an LGBTQ + person may have some family members who would support their exit, but others who are not positive or accept. Some people choose to honor both their LGBTQ + identity and their family or cultural identity by addressing only certain family members or friends.
"I present the coming out as an ongoing process and remind my customers that the need for great disclosure is only necessary if it is important to them," says Brackett. “I often see my customers come out little by little, starting with the safest people or environments to get support first. By identifying safe individuals and thinking about the possible results of the outcome, the customer can begin to collect protective factors that he needs during the process. The decision not to target people who identify them as insecure or unnecessary need not be seen as a betrayal of their identity, although this is an understandable response. It can also be framed as a means of protecting yourself. You are not required to disclose information that could endanger you. "
With every major change in life, there is grief over everything that is lost, and this is especially true for people who negotiate the way they want to be public or not, Brackett continues. "To be rejected by a family member or an important institution such as a religious community or a group of friends can be devastating," she says. “Gentleness, empathy and non-judgmental discussions are important to give customers the freedom to connect with the impacts that affect them. It is important to keep the grief, but also to lead it to the creation of a new life and support system: “Yes, it is terrible and heartbreaking. Is there someone who acted differently or with whom you felt accepted? "
Consultants can help clients build a new support system by working with them to change their family concept, says ACA member Leah Polk, licensed clinical social worker and clinical director at Change Inc., St. Louis. Customers are not limited to their families of origin; You can put together the ones of your choice, she emphasizes. Even though their families of origin have given priority to traditional scripts or rituals, the families they select can be inclusive and view each member as inherently valuable, says Polk, whose areas of expertise include LGBTQ + issues.
"The important part here is that the customer can spend time figuring out what is most important and valuable to them about the family," she explains. "You can find out how to start a family and make reliable considerations that emphasize what you like about yourself."
Peer support for transgender youth and young adults
Laura Boyd Farmer, an LPC specializing in positive LGBTQ + counseling, helped establish a peer group for youth in the Roanoke, Virginia region 10 years ago. She and other professionals in the region saw a need among the LGBTQ + youth in the region who were frequently ostracized and bullied and had little family support. "Our intention was to create a safe and supportive space," said Farmer, a member of ALGBTIC. Farmer and others sat with teenagers in the area, asking them what they needed and what kind of support would be helpful. The result was Roanoke's Youth SAGA (Sexuality & Gender Alliance).
"The children created the name," says Farmer. "They were very passionate that they wanted this to be a group for queer-identified children, but also for anyone who affirmed the diversity of gender and sexuality."
SAGA meets twice a month and there are always two managers with experience in mental health (farmer and three volunteers take turns as two leaders). Meeting times are posted on Facebook, and the group gathers in public spaces such as coffeehouses, libraries, and bookstores so that teenagers who don't go to their families have a ready-made excuse to drop by.
The group follows two basic rules: Respect the chosen identities, names and pronouns of the participants and give everyone time to speak. Group members are also asked not to speak about what is happening outside of SAGA. All participants are so invested in maintaining a place where they can find and support that, according to Farmer, there has never been a problem with the breach of confidentiality.
The structure of each meeting depends on the size of the group. If there are only a few teenagers present this week, the session is relatively informal. The group members only discuss what is going on in their life. In the case of larger groups, the leaders distribute notes so that the participants can write down all the topics that the group should deal with. The group leaders put all the notes in a bowl, which is then passed around. Each person removes a sheet of paper and reads the topic out for discussion.
Topics range from concerns such as "My parents don't want me to pass over and I don't know what to do" and "I don't know how to get out of a family member" to practices of gender identity. The group looked at logistical issues related to the physical and hormonal aspects of the transition, as well as ways in which adolescents can present themselves in a way that confirms their gender expression when their families do not let them pass them over. The teenagers also ask each other how to find good breast ties and affordable makeup.
Dealing with bullies and finding allies are also common topics, according to Farmer. She reports of an approach to bullying that she found to be particularly effective: "This trans-adolescent said that he had found the best way to deal with bullying by choosing a direct statement with which he could react and use it repeatedly" Farmer explains. "For example, when a bully told this youngster that he was really a 'she' and only confused, the youngster replied: 'That sounds like a problem with you.' This child also let his friends use the same answer when they heard someone say something unkind about him or him. I loved this approach because it gives the bully the responsibility to educate itself like holding up a mirror so that it sees that everything it says is actually about it, not about the person it is trying to harass . "
Sometimes the group has external speakers. For example, because intersection of religion with sexual and gender identity is a common concern in southwest Virginia, Farmer had a pastor discuss how spirituality and sexuality overlap. Der Pastor sprach auch darüber, was die Schrift tatsächlich über das Thema sagt (und was nicht) und gab der Gruppe Empfehlungen für die Diskussion des Themas mit der Familie.
Farmer betont, dass SAGA keine Therapiegruppe ist, sondern eine Unterstützung durch Gleichaltrige. Da Diskussionen über sexuelle und geschlechtsspezifische Identität manchmal Themen wie Traumata beinhalten, die für andere auslösen können, haben sie und ihre Co-Leiter ein Signal entwickelt, das Gruppenmitglieder verwenden können, wenn sie ausgelöst werden. Wenn jemand eine Hand auf sein Herz legt, ist dies ein Signal für die Führungskräfte, die Diskussion sanft und respektvoll vom aktuellen Thema abzuwenden. Farmer und die anderen Führer prüfen sorgfältig, ob der Teenager, der das Thema angesprochen hat, die Diskussion privat fortsetzen möchte.
"Das Schöne an dieser Gruppe ist, dass ich die Antworten nicht kennen muss", sagt Farmer. „Die Kinder teilen ihre Weisheit mit anderen. Es ist eine schöne Sache zu sehen. "
Bereitstellung einer positiven Beratung
Selbst professionelle klinische Berater, die Erfahrung mit der LGBTQ + -Community haben, können Vorurteile und blinde Flecken haben, sagen die für diesen Artikel befragten Practitioner Counseling Today. Brackett und Polk bieten einige Vorschläge für Berater an, die sicherstellen möchten, dass sie LGBTQ + -Kunden eine positive Beratung anbieten.
„Das erste, was ich empfehle, ist die Selbstreflexion darüber, wie Sie mit der LGBTQ + -Community verbunden sind, ohne Kliniker zu sein“, sagt Brackett. „Wenn Sie Ihr eigenes Engagement und Ihren Komfort in der LGBTQ + -Community verstehen, können Sie diesen Kunden auf authentische Weise präsentieren.“
Sie schlägt vor, dass sich Berater Folgendes fragen:
Sind Sie Mitglied der LGBTQ + Community? Wenn ja, mit welchen Elementen verbinden Sie sich und von welchen Elementen sind Sie getrennt? Gibt es Teile der queeren Gemeinschaft, die Sie (bewusst oder unbewusst) meiden oder nicht mögen? Wenn ja warum? Haben Sie das Gefühl, zu Ihnen zu gehören, und wie wirkt sich das auf Ihre Bereitschaft aus, mit anderen in der Community in Kontakt zu treten? Wie ändern sich Ihre Meinungen, wenn sich Rasse, ethnische Zugehörigkeit, Einkommen, Geschlecht oder Geschlechtsdarstellung der Person ändern?
Wenn Sie sich nicht als Teil der LGBTQ + -Community betrachten, wie offen und verbunden sind Sie dann mit Menschen in dieser Community? Suchen oder vermeiden Sie Orte oder Ereignisse, an denen die queere Community stark teilnimmt? Wie wohl fühlen Sie sich in diesen Räumen? Wie ändern sich Ihre Meinungen, wenn sich Rasse, ethnische Zugehörigkeit, Einkommen, Geschlecht oder Geschlechtsdarstellung der Person ändern?
"Denken Sie daran, dass es allgemeine Erfahrungen gibt, und dann gibt es die Erfahrungen Ihres Kunden", fährt Brackett fort. „Vertraue deinem Kunden, dass er dir seine Realität erzählt. Es kann mit Ihren eigenen Erfahrungen oder allgemeinen Berichten über die LGBTQ + -Community übereinstimmen, aber möglicherweise nicht. Ihr Ziel ist es, mit ihnen dort zu sein, wo sie sind, wie sie sind. “
Polk hat einige zusätzliche Vorschläge:
Lassen Sie den Client das Tempo bestimmen. Es ist nicht die Aufgabe des Beraters, eine Agenda für das Herauskommen oder den Übergang festzulegen.
Ziele in der Therapie häufig neu bewerten. Was der Klient zu Beginn der Therapie benötigt, ist oft nicht dasselbe wie das, was er nach acht bis zehn Sitzungen benötigt.
Überwachung des Sicherheits- und Entscheidungsgefühls der Kunden. Fragen Sie sie beispielsweise, wie ihre Beziehungen sind und wie sie Sicherheit in einem Umweltkontext erfahren (z. B. Beschäftigung, soziale Ereignisse, politisches Umfeld).
Scannen und bewerten Sie weiterhin nach gleichzeitig auftretenden Störungen wie Drogenmissbrauch. Individuals who identify as LGBTQ+ tend to have a disproportionate number of stressors that could lead to comorbid emotional and mental health concerns.
“Additionally, I would suggest some form of participation in LGBTQ+-affirming communities,” Polk says. “For example, attend a support group, view LGBTQ+ art [and] film, or read literature written by queer authors. Ask to interview LGBTQ+ counselors, or seek out LGBTQ+-specific supervision and psychotherapy training. Finally, perform a self-assessment of your own attitudes and biases of LGBTQ+ people to determine your growing edges in counseling.”
Brackett offers a closing thought: “If you find that you are uncomfortable with LGBTQ+ clients or are concerned about your ability to work with this population, seek out clinical supervision, and engage in your own therapy.”
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Additional resources
To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:
Counseling Today (ct.counseling.org)
Books (counseling.org/publications/bookstore)
Affirmative Counseling With LGBTQI+ People edited by Misty M. Ginicola, Cheri Smith and Joel M. Filmore
Casebook for Counseling LGBT Persons and Their Families edited by Sari H. Dworkin and Mark Pope
Group Counseling With LGBTQI Persons by Kristopher M. Goodrich and Melissa Luke
Continuing Professional Development: LGBTQ (aca.digitellinc.com/aca/specialties/137/view)
“Transgender — Moving From Awareness to Advocacy” with Becca Smith
“Affirming Counseling Practice With Queer People of Color: From Margins to Center” with Adrienne N. Erby and Christian D. Chan
“Resiliency Factors of Trans-College Students: Implications for Professional Counselors and Higher Education Professionals” with Jane E. Rheineck and Matthew Lonski
“Lesbian, Gay, Bisexual, Transgender and Queer Youth: Family Acceptance and Emotional Development” with Julie Basulto
“The Counseling Experiences of Transgender and Gender Nonconforming Clients” by Rafe Julian McCullough, Lindy K. Parker, Cory Viehl, Catharina Chang, Thomas M. Murphy and Franco Dispenza
ACA Mental Health Resources (counseling.org/knowledge-center/mental-health-resources/self-care-resources)
Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (algbtic.org)
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Laurie Meyers is a senior writer for Counseling Today. Contact her at [email protected].
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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.
