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Psychology 604 Ethics Paper heterosexist statement; one is rhetorically assuming that a particular male client has a girlfriend and that The Challenges he is heterosexual. A question like the one mentioned above can inhibit the -speciÞc experiences of and Approaches to LGBT clients (Garnets & Kimmel, 1993).

Working with , LGBT Challenges Adolescence is a time of crisis for LGBT youths , Bisexual, and trying to develop his or her identity. Like a typical adolescent, LGBT youth strive for Þtting in with Youth their peers but feel ÔdifferentÕ due to their sexual Edward M. Johns orientation (Morrow, 1993) in a society that may not have acceptance. Abstract This ÒdifferenceÓ, according to Vare (1998), comes Psychologists working with adolescents are between the age of 13 and 26 when both males and bound to encounter many unique challenges discover his or her same-sex attraction. regarding those of Lesbian, Gay, Bisexual and This age can be rather difÞcult because LGBT youth Transgendered (LGBT) youth that must be dealt not only have to deal with the same pressures that with careful considerations. As an ethical duty to the typical adolescent period pervades, but they understand and support LGBT youth, it is the purpose also have signiÞcantly higher stress levels living of this paper to explore (1) the different types of in a heterosexist society that harbors challenges that are encountered by LGBT youth such (Coleman, 1996; DÕAugelli, 2002). as stigmatization in a heterosexual society, and (2) the Homophobia, according to Lips (1988) is the techniques that can help mental health practitioners Òwidespread irrational fear and intolerance towards provide a safe and supportive environment, working .Ó This intolerance is often displayed against stigmatization and of the LGBT with verbal and physical homophobic gestures such population. as gay- jokes, , physical threats, and violence which can cause a hostile environment The LGBT population is an oppressed group with for LGBT youths. Subsequently, this can lead to a special needs that should be delineated with careful copious amount of problems in the LGBT youth consideration. According to APA (2002) ethics codes, which can escalate into numerous health difÞculties, psychologists are not supposed to engage in unfair deteriorating school performance, truancy, running based upon ; such as away from home, substance , consultation with denying people of their basic . However, mental health professionals, juvenile prostitution, most discrimination that does occur to LGBT clients psychiatric hospitalization, and are actions that therapist may be unaware of and is an disclosure, mental health, substance abuse, sexuality effect of . and sexually transmitted diseases, , According to Herek (1995), heterosexism is violence and even suicide (Crisp & McCave, 2007; deÞned as, Òthe ideological system that denies, Little, 2001; Vare, 1998). Because of the copious risks, denigrates, and stigmatizes any non-heterosexual it is important for practitioners to be aware of certain form of behavior, identity, relations or communityÓ. stigmatization, and to work towards allevating The discipline of psychology, in its most general sense, the stigmatization by providing a safe, unbiased is pervaded by this idea and by those in the practice, environment for LGBT youth in order to possibly whether by conscious or subconscious realization. decrease their potential health disparities. Psychologists who take a Òsexual-orientation- blindÓ perspective often do not see that his or her "Coming Out" and Disclosure heterosexist ideologies affect their therapeutic ÒComing outÓ is a term that is used when processes. If a practitioner were to ask one of their an LGBT individual acknowledges and accepts their male clients if he had a girlfriend, although it may sexual orientation. This Òcoming out,Óaccording to seem harmless, it can be viewed as an unintentional Mallon (2001), has a Þve-step development in which 27 LGBT youths explore their sexual orientation while LGBT youthÕs experiences of disclosing oneself, the weighing out the pros and cons. individual is a part his or her own dynamic social Stage one is the period of acknowledgement; network. As explained in steps two, three, and four, when the youth asks the question, ÒCould I be the teen explores the pros and cons of being LGBT: homosexual?Ó This is the step where the youth starts how their social groups will play into to them being to explore his or her feelings about being homosexual homosexual, the reaction from family, school, and whether or not they are consciously attracted to friends. If an individualÕs family is not accepting of members of the same sex. homosexuality it may cause the individual added Stage two of this Òcoming outÓ is when stress and guilt (Beaty, 1999), and the LGBT youth the individual thinks critically about his or her could potentially be kicked out of his or her house sexuality while considering the possibility of being because of the disclosure of their sexual orientation homosexual. This sexual orientation seeking is usually (Shelby, 1998). All of these scenarios are what youth accompanied with questions such as Òam I?Ó and must consider before deciding if they are going to ÒWhat happens if I am?Ó Òcome out.Ó It is a life changing growth that has In this stage of acknowledgement, there is also the potential of affecting their physical and mental . Some people, when questioning their sexuality, wellbeing, setting the precedence for the rest of their retract and choose to deny his or her feelings because life. of the homosexual . They themselves have often seen and compared themselves to people Mental Health who have Òcome outÓ, have been harassed, or have During the discovery of oneÕs sexual heard anti-gay slurs, which can make it a difÞcult orientation, LGBT youth are likely have an increased period for adolescents who are still uncomfortable. risk of mental health disparities, one of the most The third stage of Òcoming outÓ is when an prominent mental health problems being individual believes they are probably homosexual and suicidal ideation (Crisp & McCave, 2007; and at this point, have usually come to terms with DÕAugelli, 2002; Shelby, 1998; Vare, 1998). Other the social stigma of homosexuality, pushing through issues, such as being victimized at school, and being negative societal impressions of LGBT, such as the threatened physically and verbally, relates to the of being promiscuous, as well as their own. development of posttraumatic stress symptoms. At this stage, the youth is likely to engage in activities ItÕs estimated that over a third of all LGBT students such as dating people of the same sex and possibly that have had health problems have attempted to engaging in sexual intercourse. Because these teens as commit suicide, which, according to DÕAugelli et al still so vulnerable, these actions can be harmful. (2001), is signiÞcantly higher than that of the general Stage four is when an adolescent fully accepts his population; there are likely to be many more suicides or her sexual orientation and chooses this to be an and suicidal attempts that have not been recorded identifying factor in his or her life. During this time, (DÕAugelli, 2002). adolescents usually choose to disclose their sexual Substance Abuse orientation to others but it is also a stressful time for Research has shown that LGBT adolescents, adolescents because of the potential for rejection in addition to mental health problems, encounter from family and friends. During this time, teens increased risks of developing heavy substance abuse have generally gauged whether or not it would be problems due to the different harassments that they appropriate for them to disclose their information are subjected to (Crisp & McCave, 2007; Little, 2001; or not. For people who grew up in families where Vare, 1998). According to Shelby (1998), LGBT youths homosexuality is not accepted, they may not choose are 1.6 times more likely to report heavy substance to declare their sexual orientation. If not dealt with abuse to escape the emotional and physical pain that in an adaptive manner, this choice can result in they encounter and potentially develop substance psychological harm such as low self-esteem and problems later in life which include withdrawal and suicide. isolation from family, school, and friends (Little, 2001). The Þfth stage, a stage that generally is not accomplished until young adulthood is over, is fully Sexuality and Sexually Transmitted Diseases coming to terms with being LGBT. ÒIdentity crisisÓ no As many LGBT adolescences begin to explore longer becomes an issue and the person is now able, their sexuality, most are ill-informed about safe sexual if they choose, to focus on other important aspects of practices, many are disowned from their families and their life such as education, or on work. forced into sexual exploitation (Durby, 1994), risking Although the Þve stages listed above describe an contracting STDs including syphilis, gonorrhea, HIV, chlamydia, and hepatitis B (Crisp & McCave, 2007). Knowledge In other cases, some LGBT, especially gay males, will Knowledge is a key element in providing try to Þt in by engaging in sexual intercourse with a culturally competent services to LGBT youths (Crisp as a way to pass as a heterosexual (Morrow and McCave, 2007). Within this knowledge, there 2004). are seven sub-areas of knowledge that practitioners should be familiar with in order to understand the Harassment and Violence dynamic of the LGBT culture and their signiÞcance Harassment and violence is considered, along in the mental health practice. The seven categories with discrimination, direct and overt oppression of knowledge are: (1) terminology; (2) demographics towards the LGBT population. Research has shown and ; (3) symbols, historical dates, and that LGBT see from peers and family contemporary Þgures; (4) experiences with oppression members once their sexual orientation is disclosed and policies that impact LGBT youth; (5) community (Garnets et al, 1993) but that most of the abuse occurs resources; (6) culturally sensitive practice models; in school. According to Little (2001), educational and (7) "coming out" models and identity as a LGBT institutions are lagging in the support for LGBT person. students who encounter harassment and violence. According to DÕAugelli et al (2002) half of LGBT Terminology students have been verbally abused: one quarter It is important for practitioners to familiarize threatened with violence, and ten percent attacked in themselves with the proper terminology that is school. Due to this large amount of , twenty- associated with the LGBT community. According eight percent of students drop out of school (Shelby, to Advocates for Youth (1994), many youth can 1998). This harassment and violence adds to the Þnd different types of terminology offensive. For LGBT challenges of mental health risks due to the example, the word "homosexual" is generally seen depression that is caused by the fear and hatred from as offensive to youths. However, words such as other people. Òlesbian,Ó ÒgayÓ and ÒbisexualÓÕ do not weigh and hold the same stigma that the word ÒhomosexualÓ Conclusion of Challenges holds (Mallon, 2001). All of these terms can and do What is important to remember about imply heterosexual normalcy and can make a LGBT the preceding challenges of LGBT youth is that youth feel uncomfortable. Instead, practitioners although each challenge does have its own unique should try to utilize -neutral terms such as characteristics, and while all seem independent, words like ÒpartnerÓ instead of ÒboyfriendÓ and all problems LGBT face are interdependent, ÒgirlfriendÓ (Phillips et. al., 1997). In addition to word interconnected, and mutually condition each other. choice, practitioners should also be familiar with the For example, harassment and violence can both affect different types of verbal harassment words that are the mental wellbeing of an LGBT youth and have an utilized in schools and public so practitioners are able effect on their coming out and disclosure process. It to understand a clientÕs situation. This is important is important that we look at these challenges as a because if a client describes harassment that they dynamic organism in which one challenge can, and is have experienced, the practitioner can establish an likely to, be an effect of other ones. empathetic rapport with the client. Finally, it is also important to be familiar with general words and Strategies for Mental Health Professionals symbols that clients may identify with. One example The challenges of LGBT youth show that is that of the word "." Some adolescents are there is great need for mental health support. Due to comfortable with the word "queer" and practitioners the uniqueness of the particular population of LGBT should be aware and respect their choices of word. adolescents, the most appropriate multicultural and supportive environment should be established for Demographics and Diversity LGBT youth who seek mental health assistance. Van LGBT youths are a part of a diverse group Den Bergh and Crisp (2004) introduced a culturally of people with many commonalities but also many sensitive model of working with LGBT youth called multicultural differences which practitioners should AfÞrmative Practice. AfÞrmative Practice involves be aware of (Ryan and Futterman, 1998). For example, three dimensions: knowledge, attitudes, and skill some are more accepting of LGBT youths that, when practiced in a professional setting, create a than others are. With this knowledge, practitioners supportive environment for LGBT youths. can further help the therapeutic process even more

29 if they are open to understanding the complex and Culturally Sensitive Practice Models diverse LGBT populations. It is essential that practitioners who work with LGBT youths are familiar with culturally- Symbols, Historical Date, and Contemporary competent models and approaches to treatment. Figures Unlike a Òsexual-orientation blindÓ approach For both practitioners and clients, learning explained in the beginning of this paper, culturally about the history and symbolism of the LGBT culture sensitive models take careful consideration of the can help bridge the connection between client and traditions and practices of the client that is being practitioner. Many LGBT youths are ashamed of treated. To disregard the LGBT youthÕs own culture being who they are and it is important for them to means quite possibly alienation from practitioners be aware of the different type of prideful things that and increases the chance of them falling victim to are a part of their cultures. Key historic periods such harmful behavior. Having a culturally sensitive as the Riots, where the LGBT population approach to clients including LGBT youth allows fought back against oppression, can restore a sense for fewer chances of intentional oppressive and of pride in clients who are shameful of their identity. discriminatory actions from the practitioner. Knowledge of symbols such as the rainbow ßag, and key Þgures, such as , who was the Þrst "Coming out" models and identity as a LGBT openly gay elected ofÞcial, may help the therapeutic Person process by providing icons and role models that the ÒComing outÓ is an important aspect that LGBT adolescent can look up to. nearly every LGBT person encounters in their lifetime. Practitioners should become aware of the process Experiences with Oppression and Policies that of coming out so that he or she can help facilitate a Impact LGBT Youth successful transition with the LGBT youth. MallonÕs It is important for practitioners to be aware Òcoming outÓ stages (2001) which were previously of issues regarding institutionalized oppression explained, is an example of a coming out model. and try to understand that dynamic from a LGBT Although the stages in which a person identiÞes perspective. Practitioners who have not experienced themselves as a LGBT may be very similar for this may not be aware of the social pressures that are everyone, every transition is unique to the individual. put upon LGBT youth. For example, heterosexuals "Coming out" models and approaches should be are allowed to marry in all US States and homosexual used only as guidelines due to the uniqueness of this are not with the exception of one. There are also transition. many employment and housing provisions that do not protect LGBT people from being discriminated Attitudes against. Practitioners should be informed of these APA Division 44 (2000) encourages that different policies that can possibly cause stress on practitioners self-examine their beliefs, values, their clients so that appropriate measure can be and attitudes towards LGBT individuals to ensure taken to help the client be successful regardless of that they are striving for what the client needs in discriminatory policies. order to be a successful individual. It is crucial that practitioners check their attitudes while working Community Resources with LGBT youth clients because even the littlest Since LGBT youth are at a high risk for hint of negative body language or speech can affect health disparities, it is important that practitioners the therapeutic process (Ryan and Futterman, familiarize themselves with the resources that are 1998). If personal are not controlled, it can available to LGBT youth. Organizations such as harbor self-hatred in the client and lead to denial the National Youth Advocacy Coalition and the about challenging issues (Crisp & Mc Crave 2007). Gay, Lesbian, and Straight Education Network have If practitioners cannot change their attitudes about lists of resources that are available to the public for their LGBT clients, they should refer their clients in people who wish to seek different services or support a timely fashion to a practitioner who will give the groups. Practitioners can also familiarize themselves client the support and service that they need. It is with their local LGBT resources available for youth. important however, to remember that if a negative Sharing resource information to clients provides them feeling does occur after a relationship has been with multiple ways they can seek support that will established; it may be difÞcult to refer the client; other promote their wellbeing. ethical considerations must be taken into account.

like internalized homophobia, that already exist for Skills the client, the practitioner can work with them to help Skills are a key component to creating a them understand their experiences and work through culturally competent therapeutic environment for them, beneÞtting the clientÕs path of self-discovery. LGBT youths. Crisp and McCave (2007) outline ten skills that practitioners are encouraged to practice: (1) Determine How ÒOutÓ a Youth is and Who create a safe environment for LGBT youth; (2) assess, Supports the YouthÕs Sexual Orientation donÕt assume, a LGBT youthÕs sexual orientation. (3) There are LGBT youth who choose not to help youths work through the stages of the coming disclose their sexual orientation. Practitioners should out process; (4) determine how ÒoutÓ a youth is and be aware of the youthÕs choices, and work with them who their support group is; (5) treat the presented to Þgure out a support network that he or she can rely challenge, not the youthÕs sexual orientation; (6) on through this challenging time. examine the present challenge in the context of Treat the Presenting Challenge, Not the YouthÕs their lives as both youth and LGBT individuals; (7) Sexual Orientation work with family members to accept LGBT youth Practitioners should not assume that a youthÕs and support their identities; (8) refer youth to gay- problems are due to their sexual orientation. It is afÞrmative resources; (9) acknowledge negative important to explore the different causes of a youthÕs feelings about LGBT youth and work to address these problems, and develop an appropriate strategy. A feelings; and (10) engage in ongoing training and failure to do so may cause the client to work against continuing education around LGBT issues. positive identity development.

Create a Safe Environment for LGBT Youth Examine the Presenting Challenge in the Creating a safe environment for LGBT youths Context of their Lives as Both Youth and LGBT allows them to be comfortable in disclosing sensitive Individuals information within the therapeutic process. Some of As explained previously, the LGBT youth the ways a practitioner can create a safe environment population is very diverse. It is important to is by staying current with sensitivity trainings and understand that practitioners must look at a youthÕs different supporting organizations who advocate problem from different angles, considering the LGBT. For example, Þnding an organization in your viewpoint of the youth as a LGBT. For example, own hometown such as PRIDE Hilo, or an LGBT club a LGBT youth could be African American and on college campuses is a way in which a practitioner encounter racial problems that do not occur because can work towards creating a safe environment for he or she is LGBT. It is important to understand the LGBT youths. dynamics between an individualÕs multiple identities, in this case ones sexual orientation and ethnicity. Assess, DonÕt Assume, LGBT YouthsÕ Sexual Orientation Work with Family Members to Accept LGBT It is important that clients are not judged Youth and Support their Identities as heterosexual by practitioners. The goal for any ÒComing outÓ affects not only an LGBT practitioner is to try to assess what it comfortable youth, but also their family. It is likely to be a difÞcult for their client and to not assume that they are of time for both parties. According to Savin-Williams one particular group. It is also important to allow (1996), families need to adjust their expectations of the client to self-identify rather then verbalize an their child. PractitionerÕs duties are to help maintain assumption. Practitioners should avoid labeling and keep the connections between the LGBT youth clients and let them choose how they would like to be and their families by developing strategies because identiÞed. family is an important support system for the individual. Help Youth Work Through the Stages of the Coming Out Process Refer Youth to Gay AfÞrmative Resources During adolescence, LGBT youth are in the Practitioners should refer their clients to process of integrating their into their resources that support their identity. By encouraging sense of self. This is a challenging task and youths clients to look up and utilize these afÞrming resources may need assistance integrating these two identities. can potentially increase that clientÕs self-awareness It is important that the practitioners help clients to and self-esteem about being LGBT. This, in turn, make careful considerations with the disclosure of fosters pride and security with in the individualÕs their sexual orientation. Being aware of the challenges, choice to disclose his or her sexual orientation.

Acknowledge Negative Feelings about LGBT Conclusion Youth and Work to Address these Feelings When one sees the challenges that LGBT All practitioners are likely to encounter an youths must go through in order to establish their LGBT client. For some practitioners, it is difÞcult own identity, it is very disappointing. Who can one to get past the negative biases that they may have. turn to when they see a society that does not foster It is important that practitioners become aware of multicultural understanding for LGBT populations? their biases and strive towards fostering beneÞcial For this reason, the role of the mental health relationships for an LGBT youth. There are different practitioner is vital. It is vital that they be educated, ways a practitioner can assess their LGBT biases. One trained, and meet the needs to work with diverse way is by taking psychological tests. Some of these populations such as LGBT youths. Though there tests include the Attitudes Toward Lesbian and Gay has been much improvement regarding tolerance Men Scale (Herek, 1988) and the Gay AfÞrmative towards LGBT, and although guidelines are set to help Practice Scale (Crisp, 2006). accomplish the task of meeting the needs of LGBT youths, society is still far from eliminating oppression Engage in Ongoing Training and Continuing Education Around GLB Issues. and discrimination. But there is hope. Many One of the most important things that a associations such as the American Psychological practitioner can do to ensure that he or she is Association, American Counseling Association, and culturally competent for LGBT youth is staying up to the National Association of Social Workers recognize date with literature, news, and trainings that pertain the LGBT population for who they are. It cannot be to LGBT issues. Education and training are key in only practitioners, but societies in general, that must making sure that practitioners are able to provide the also see that if we are likely to see continual social best service that is possible. improvement in favor of LGBT youths, we must Þrst realize it in ourselves.

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