1. Just A Little Bit About Working with the LGBT Population Jennifer Johnson, LCSW 1

2. In 2008 alone, there was a spike in violent crimes against LGBT people. Overall, the FBI reported a 1 percent decline in hate crimes in the U.S. last year – but a 6 percent increase in hate crimes against gay, lesbian and transgender people. Federal Bureau Of Investigations, 2009 2

3. Cultural Victimization Richmond Ca December 13, 2008 – a 28 yr old lesbian – attacked, gang raped by four men, moved to another location and beaten and gang raped again all while the men were making slurs about her sexual orientation. Oxnard Ca Feb 12, 2008 – 15yr old Lawrence King an openly gay youth, known as the ‘sassy gay kid’ by school peers shot twice in the head in front of classmates while in the schools computer lab. Greely Co July 16,2008 – 20 yr old Angie Zapata bashed in the head with a fire extinguisher when her male date discovered she was transgendered. Greenville SC May 21, 2007 – Sean Kennedy murdered outside of a gay bar -his assailant making derogatory comments regarding Kennedy’s sexual orientation, while fatally beating, punching and smashing his head into the pavement until dead. These events demonstrate a continued hatred and misunderstanding of the LGBTQ population 3

4. The power of the ism’s - racism, sexism, heterosexism… Not everyone has to be racist or sexist or heterosexist. It is simply that enough prejudices occur institutionally and socially that the shame is internalized, leaving the victimized population to carry on the devaluing of self. 4

5. Common to all hated minorities is the damage done to self-image by the internalization of that hatred. Erikson (1959) asserts that it is impossible for any member of a hated minority to escape that internalized hatred. (unique stressors – among minorities) 5

6. These culturally victimizing experiences lead to increased feelings of fear and insecurity with in the LGBTQ community. Human Rights Campaign 2009 6

7. Fear & Insecurity Lack of acceptance for one’s authentic self Difficulty connecting with others Increased conflict with loved ones General pervasiveness of unhappiness Intense sense of rejection 7

8. The Healing Process from Cultural Victimization 1. Breaking the silence 2. Establish perpetrator responsibility 3.Reclaim personal power Neisen, J (1993). Healing from Cultural Victimization: Recovery from Shame Due to Heterosexism. Journal of Gay & Lesbian Psychotherapy, 2(1) 49-62 8

9. Breaking the Silence The ability to identify as LGBT and tell their story. Telling about their struggles Telling about coming to terms with being LGBT Talking about events that may have happened during the realization process Telling about times of acceptance Telling about times of non-acceptance. 9

10. Breaking the Silence Encourage a discussion of how the client hid his/her feelings from others. Explore the emotional costs of hiding and denying one’s self. Discuss the attempts the client has made to change, in an effort to fit in. Examine negative feelings of self-blame, feeling ‘bad’ or ‘sick’, and the impact of shaming messages on the client. (external to internal) 10

11. Establishing Perpetrator Responsibility Identifying the role that heterosexism has played in their struggles to accept themselves. Recognizing heterosexism as oppression, victimization and abuse - shift clients’ perspective by drawing parallels to the process of recovery as it relates to all forms of abuse. 11

12. Establishing Perpetrator Responsibility Help clients understand that anger and a negative self-image are the result of cultural victimization and not a personal defect. Help the clients manage that anger in a constructive manner rather than direct it toward themselves. 12

13. Establishing Perpetrator Responsibility may sound like: “I didn’t do anything to deserve to be beaten, raped, assaulted, mugged, molested or bullied…I didn’t do anything to have a hate crime done to me…that was not my doing…I am not to blame…it was the perpetrators doing” 13

14. Treatment with this population often involves developing an understanding that… Their depression, anxiety, self-loathing, substance abuse… is not because they are homosexual rather it is often an effect of cultural victimization/heterosexism. Adversity has its impact on the physical and emotional well being of GLBT individuals 14

15. Reclaiming Personal Power Improving self concept and self confidence. Riding one’s self of internalized negative messages about their LGBT status. Changing these internalized negative messages to self affirming and positive messages. Debunking the myths/stereotypes while researching for current and accurate facts. 15

16. Reclaiming Personal Power Recognize residual shame as it relates to victim mentality and begin to release it. Integrate public and private identities. Build a support network of individuals who accept and value them for who they are. Foster the client’s courage to accept and speak up about who he or she is. 16

17. Hate Crime Victim Short-term Objective: Challenge negative self talk and replace with more realistic and fact based beliefs. Therapeutic Intervention: Educate client about recording automatic thoughts to identify negative self talk (e.g.., “I was attacked because I am too effeminate/masculine”) Assist client in replacing distorted, unrealistic self-talk with realistic self-talk that does not blame self for assault (e.g., “I was attacked because the assailant was virulently homophobic”) 17

18. The Coming Out Process Is already a difficult process and if the feelings of fear and insecurity are heightened due to known events of violence and hatred then this process becomes even more difficult to navigate. So its important for therapists to have some specific knowledge on the coming out topic. 18

19. Coming Out Process Stage models provide a useful description of the process by which some people come to call themselves gay or lesbian. Stage models are general guidelines to help therapists understand the coming out process. The models are not linear, and people do not necessarily move through them in order. Cass, V.C., 1979. Homosexual identity formation: A theoretical model. Journal of Homosexuality 4(3): 219-235 19

20. Stage 1: Identity Confusion Involves some denial and confusion regarding one’s feelings of attraction and sense of self. Individuals see their behavior as homosexual and face some sort of crisis about who they are. Some use AOD’s to manage the painful feelings of this stage. 20

21. Sexual Identity Confusion Short-Term Objective: Verbalize an increased understanding of homosexuality Therapeutic Intervention: Educate client about the range of sexual identities possible Assign client homework to identify some myths and stereotypes about homosexuals and then assist in replacing them with more realistic, positive and fact based pieces of knowledge Assign client readings which provide accurate positive messages about homosexuality Utilize appropriate web sites: www.thetrevorproject.org, About.com, HumanRightsCampaign.org… 21

22. Many Configurations Are Possible Biological Sex Male Intersexed Female anatomy, chromosomes hormones Gender Identity Man Bi-gendered Woman psychological sense of self Gender Expression Masculine Androgynous Feminine communication of gender Attracted to: Sexual Orientation Women Both Neither Men physical, romantic, emotional attraction 22

23. Stage 2: Identity Comparison People begin entertaining the possibility that they may be gay or lesbian. (“I might be …”) Anxiety is heightened as people deal with their denial about their sexuality. Often are in emotional pain and are quite vulnerable. AOD use is often a way of dealing with the pain associated with an experience that breaks through their denial and shatters their sense of heterosexual identity. 23

24. Stage 3: Identity Tolerance Begin to have a greater level of commitment to a new identity (“I probably am gay/lesbian”). These feelings increase the sense of alienation and isolation. In response, people seek out gay/lesbian individuals. Try to connect with the gay community and culture. 24

25. Educational LGBT Films to Use with Clients For the Bible Tells Me So Middle Sexes Anyone and Everyone Fish Can’t Fly Out of the Past 25

26. LGBT Educational Readings to Use with Clients Now That You Know Christianity, Social Tolerance and Sexuality Lesbian Origins Living Two Lives Confessions of the Other Mother Love Makes A Family Out in All Directions Magazines: The Advocate, Curve, The Gay & Lesbian Review… 26

27. Stage 4: Identity Acceptance Increased contacts with other gay and lesbian individuals. Involves experiences that help ‘normalize’ a gay or lesbian identity and a way of life. May have fragile identities and find it difficult to cope with non-LGTB people who do not understand their need to be with people similar to them. 27

28. Stage 5: Identity Pride An awareness of the difference between their acceptance of their own homosexuality and society’s rejection of it. Tendency to get angry, to split the world into gay and straight, and to respond to heterosexism by rejecting the dominant heterosexist culture. (‘Us vs. Them’) May become active in the lesbian/gay community and spend the majority of their time with those that share their feelings and perspectives. 28

29. The Actual Coming Out ? Identify and discuss advantages and disadvantages of disclosure to family or others. Explore reasons for coming out – what are you hoping for – what happens if it doesn’t go well. Assign client to write detailed plan of how to disclose sexual orientation to family (e.g., who is to be told, where, when, exactly what are you disclosing) and process this plan and its ramifications in session – repeatedly! 29

30. Coming Out ? Have client role play disclosure of his/her orientation to family in session. Ask client several pointed questions about sexual orientation that are likely to be asked - so client is prepared to handle such questions with minimal amounts of anxiety! Did we make you gay? Do you want to be the opposite sex? Do you have AIDS? Did someone hurt you? Is it because we let you go to that liberal private college? 30

31. Stage 6: Identity Synthesis An awareness that the dichotomy of “them” and “us” is not valid. Anger decreases. Pride becomes less aggressive. The gay or lesbian identity is more integrated with other aspects of the individual. Worked through the process of claiming a positive gay or lesbian identity – feeling good about themselves as a gay man or lesbian woman. 31

32. Assist in the Healing Thank you Jennifer Johnson, LCSW 32