Transcript sexual minority youth

C O U N S E L O R S W O R K I N G E F F E C T I V E LY
WITH SEXUAL MINORITY YOUTH
& T H E I R FA M I L I E S .
S t e v e F a r m e r, P h . D . L P C , L M F T, N C C
Assistant Clinical Professor
Northern Arizona University
Morgan Regalado, B.A.
Northern Arizona University
A a r o n A s t e r, B . S .
Northern Arizona University
Danielle Ruberto, B.S.
Northern Arizona University
Presented to the International Association of Marriage and Family Counselors
Wo r l d C o n f e r e n c e , M a r c h 1 1 , 2 0 1 6 , N e w O r l e a n s , L A .
Learning Objectives
1. Participants will gain an understanding of sexual identity
2.
3.
4.
5.
and gender identity development
The issues and risks sexual minority youth face
Parent perspectives and family acceptance of sexual
minority youth
Counselor’s role and best practices
Through role-play counselors will practice skills for
working with sexual minority youth
Sexual Minority
Queer
Gay
Gender
Dissonance
Lesbian
Questioning
Gender Queer
Asexual
Gender Fluid
Cisgender
Pansexual
Bisexual
Transgender
Third Gender
Intersex
Homosexual
Gender
Variance
What is Sexual Identity?
Sexual identity is defined as the understanding and
expression of one’s sexual sense of self.
 Sexual identity is not reducible to:
o Sexual orientation
o Erotic desire
o Sexual behavior
o Emotional/Romantic attraction
o Socialization
Sexual Identity Development
Understanding one’s
own sexual self
Accepting one’s
sexual self
Identifying as
heterosexual,
homosexual, lesbian,
gay, or some other
sexual identity
Sexual identification is influenced by an authentic inner experience and
interaction with others (family, community, social expectations, categories
available, role models, friends, relationships)
What is Gender Identity?
Gender identity is defined as one’s innermost concept of
self as male, female, a blend of both or neither.
 Gender Identity includes:
o How an individual perceives themselves
o What an individual calls themselves
o Gender identity can be the same or different from their sex
assigned at birth
Transgender Identity Development
“I wish I
was a girl!”
Ages 2-3
Identity starts
to become
clear
Ages 3-4
Awareness of
Anatomical
Differences
“I want to be
a boy when
I grow up.”
Ages 4-6
Belief
another
gender is
possible
My body
has
betrayed
me.
Ages 5-7
Understands
gender will
not change
Ages 9-12
Gender
dysphoria
strengthens
Ages 12-18
Feelings of
going
through the
wrong
puberty
(Brill & Pepper, 2008)
SEXUAL MINORITY YOUTH
RISKS AND ISSUES
LGBT youth are at higher risk for bullying,
physical assault, substance abuse, mental
health problems, suicide, and
homelessness from being kicked out of
their homes by unsupportive parents.
(Gragg, 2012)
Sexual Minority Youth Data
• LGBTQ individuals are almost 3 times more likely than others to
experience a mental health condition such as major depression or
generalized anxiety disorder.
• The fear of coming out and being discriminated against for sexual
orientation and gender identities can lead to depression,
posttraumatic stress disorder, thoughts of suicide, and substance
abuse.
• LGBTQ youth are at higher risk for self-harm and thoughts of suicide,
and LGBTQ teens are 6 times more likely to experience symptoms
of depression than the general population.
(National Alliance on Mental Illness – NAMI)
Survey Data (n=10,000)
LGBT youth are nearly twice as likely to be
called names, verbally harassed or physically
assaulted at school compared to their nonLGBT peers.
LGBT youth are more than twice as
likely to experiment with drugs and
alcohol.
4 in 10 (42%) LGBT youth say the
community in which they live is not
accepting of LGBT people.
About half (49%) of LGBT youth say they
have an adult in their family they could turn to
for help if they felt worried or sad (compared
to 79% of non-LGBT youth).
(Human Rights Campaign, 2013)
Homelessness in Sexual Minority Youth
Survey found that LGBT youth
represent between 30% and 43%
of those served by drop-in
centers, street outreach
programs, and housing programs:
 Host Home Programs – 42% of
clients identified as LGBT (LGB =
37%; transgender = 5%)
 Permanent Housing Programs - 39%
of clients identified as LGBT (LGB =
36%; transgender = 3%)
 Transitional Living Programs - 22% of
clients identified as LGBT (LGB =
19%; transgender = 3%)
 Independent Living Programs – 22%
of clients identified as LGBT (LGB =
19%; transgender = 3%)
 Emergency Shelters – 21% of clients
identified as LGBT (LGB = 17%;
transgender = 4%)
(Durso & Gates, 2012)
Transgender Youth
Singh, Meng, & Hansen (2014) identified 6 major
threats to the resiliency of transgender youth:
Experiences of adultism – “It’s a phase.”
Health care access challenges
Emotional and social isolation
Employment discrimination
Limited access to financial resources
Gender policing
Additional Data
 Social support of sexual minority youth is directly related to distress variables
 40% more likely to report feelings of sadness and hopelessness in the past 2 weeks
 Transgender youth are 30% more likely to report suicidal ideation and 21% more likely to
engage in self-harm
 Data shows that LGB youth are more than twice as likely to have considered attempting
suicide than their heterosexual peers (30% vs, 14%)
 A study found the prevalence of self-harm was particularly high among LGBT males (41.7%)
 Rates of anxiety were 40.4% for transgender women and 47.5% for transgender men
 58.7% of bisexual women had a lifetime history of mood disorder compared with 44.4% of
lesbian women, 36.5% of women who were unsure about their sexual identity, and 30.5% of
heterosexual women
 Found rates of depressive symptoms were 51.4% for transgender women and 48.3% for
transgender men
 Gay men had a higher prevalence than heterosexual men of any lifetime mood disorder
(42.3% vs 19.8%) and of any lifetime anxiety disorder (41.2% vs 18.6%)
 LGBT youth score significantly higher on the scale of depressive symptomology
PA R E N T ’ S P E R S P E C T I V E &
FA M I LY A C C E P TA N C E
Parent’s Reaction
Parents describe the disclosure event in ways that
indicated a high degree of stress and/or
emotionality.
Not uncommon for both the child
and parent to cry
Significant degree of tension may be
felt by parent and/or child
Feeling shocked or surprised is a
common initial reaction
Fear for child’s well-being is a
common reaction
In addition to negative reactions that affect the youth’s wellbeing, common parent reactions include:
“It’s just a phase!”
“Are they gay or lesbian?”
“Are they mentally ill?”
“What did I do wrong?”
A Developmental Model of Parent Reactions
• Denial provides a buffer zone, a time for parents to re-gain their bearings and equilibrium
• Isolation may be initially helpful, a time to process the evidence and perhaps move toward an initial but
Denial and
partial acceptance of the fact.
Isolation
Anger
• Denial can last only so long before a sense of control vanishes
• Parents may then react with agitation, dismay, or rage at their child
• An attempt to regain equilibrium by working out “a deal”
Bargaining
• This stage is characterized by depression and in some cases, resigned tolerance.
• This is the anger stage turned inward, a guilt parents feel for not recognizing their child’s “condition” early
enough to change the outcome or for being the kind of parent that “causes” a child to be LGBT
Depression
Acceptance
• Family equilibrium becomes restored and the son’s or daughter’s homosexuality is no longer a family
secret or a source of shame
(Williams & Dubé, 1998)
Themes of Parent’s Perspectives
Several themes that reflected what common issues parents
are struggling with:
 Lack of social scripts to assist them in learning their child
was LGBT
 Dealing with a sense of loss
 Wanting to encourage heterosexual norms with their
children
 Fear of child’s safety and well-being
 Confronting the concept of normalcy
Parent’s Perspective to Gender Identity
Questioning Youth
According to Vanderburgh (2008), parents seek help for
various reasons that include:
 Questioning if a mental illness exists
 Indecisive on directing a change in their behavior or
identity
 To understand better by seeking resources &
information
 Advocacy and advice for children actualizing a new
gender
 Professional support as their family moves forward
with actualizing their child’s identity
Additional Data
• Ryan & Diaz (2005) across ethnic, socioeconomic, and
geographic lines, the study participants reported similar
experiences.
• Parents express urgent need for information and contact
with other families experiencing similar issues
• Parents often have particular difficulty accepting their
child’s emerging LGBT identity when the child is an
adolescent or preadolescent for whom they are
responsible and over whom they expect to have ongoing
influence.
• Some parents could not reconcile their child’s sexual
orientation or gender identity with their own strongly held
religious beliefs or moral views.
Family Acceptance of LGBT Youth
Have higher self
esteem
Have better
mental health and
overall health
Are much less
likely to be
depressed
Are more likely to
believe they will
become a happy,
productive adult
Are more likely to
believe they will
have a good life
Are much less
likely to use illegal
drugs
When Families
are accepting
and supportive
of their LGBT
youth
Are much less
likely to think
about killing
themselves or
attempt to commit
suicide
(Ryan, 2009)
Supportive Behaviors of Parents
Talk with child about their LGBT identity
Advocate for your child when he or she is mistreated because of their LGBT identity
Connect your child to LGBT organizations, events and roe models
Work to make your church supportive of LGBT members, or find a supportive faith
community
Welcome your child’s LGBT friends or partner to your home
Support your child’s gender expression
Believe your child can have a happy future as an LGBT adult
COUNSELOR’S ROLE
& BEST PRACTICES
Counselor’s Role
• Empathy for LGBT youth
• Check one’s own values
• Empathy for parents of LGBT
around sexual identity,
gender identity and
expression, adolescent
development and parent
support
• Knowledge of advocacy
models
• Knowledge of ethics and
laws around counseling
minors
youth
• Education for self, LGBT
youth and parents
• Sexual identity and gender
identity
• Sexual and gender identity
development
• Adolescent development
• Family life cycle
Best Practices
 Seeing parents and family as a supportive resource
 Providing accurate information on sexual orientation and
gender identity
 Helping parents who react to their LGBT children with
ambivalence and rejection understand how their reactions
contribute to health risks (Ryan & Chen-Hayes, 2013).
 Meet parents where they are – build an alliance for the
support of the LGBT child
 Teach and model LGBT-understanding, LGBT-accepting
and LGBT-supportive behaviors
Transgender Youth Resiliency
Ability to
self-define
and theorize
one’s gender
Proactive
agency and
access to
supportive
educational
systems,
Connection
to a transaffirming
community,
Reframing of
mental
health
challenges
Navigation
of
relationships
with family
and friends
(Singh, Meng, & Hansen, 2014)
Counselor’s Role & Best Practices
“Trans identity is a real-world, whole-life issue that the therapist
can only glimpse during a session.”
• Check your biases
• Check your counseling modality
• Assess the family structure
• Read literature (professional & personal accounts of trans individuals)
• Become knowledgeable of community resources
• Therapists
• Endocrinologists
• Psychiatrists
• Support groups for child and caregivers
• Be willing to advocate
• Be aware of language used by yourself, other professionals, clients,
and their families
CASE SCENARIO
Counselor Tasks BEFORE Parent Session
• Clearly understand young client’s goal: coming out,
getting parent support, changing parent’s mind
• Role play, discuss expectations, possible scenarios
• Identify how counselor and young client will share
communication to parents
• Client doing it on their own
• Client and counselor together
• Counselor session with just the parents
Counselor Tasks IN Parent Session
• Assess parent level of support
• Reflect parent’s concerns to increase counselor’s
empathy and connect with parent
Client & Family
Andrea is a 14 year old Hispanic female. She’s a freshman
in high school and she comes to your counseling center
after being referred by teachers and school counselor.
Andrea’s school performance has suffered in the past year
and the school counselor has seen symptoms of
depression. Andrea’s mother has been bringing her to your
office and you’ve met with Andrea three times. During those
sessions, Andrea has shared with you that she is a lesbian.
She has a girlfriend at school and she’s worried her parents
won’t understand or support her sexual identity or her
relationship. Andrea has set a goal to come out to her
parents and you’ve helped her prepare for that.
Role Play
1. In groups of three or four, create a short dialogue
between the counselor, Andrea, her mother, and an
optional other family member
2. What specific skills would the counselor need to use in
this conversation?
Resources for Sexual Minority Youth &
Parents
• Gay-Straight Alliance Network
• PFLAG
• Family Acceptance Project
• LGBT Centers Directory
• The Trevor Project
• It Gets Better Project
Our Website
COUNSEL.CARE
Resources
Almeida, J., Johnson, R. M., Corliss, H. L., Molnar, B. E., & Azrael, D. (2009). Emotional distress among
LGBT youth: The influence of perceived discrimination based on sexual orientation. Journal Of
Youth And Adolescence, 38(7), 1001-1014. doi:10.1007/s10964-009-9397-9.
Bernal, A. T., & Coolhart, D. (2012). Treatment and ethical considerations with transgender children and youth
in family therapy. Journal Of Family Psychotherapy, 23(4), 287-303.
doi:10.1080/08975353.2012.735594.
Brill, S. & Pepper, R. (2008). The transgender child: A handbook for families and professionals. San
Francisco, CA: Cleis Press Inc.
Budge, S. L., Katz-Wise, S. L., Tebbe, E. N., Howard, K. S., Schneider, C. L., & Rodriguez, A. (2013).
Transgender emotional and coping processes: Facilitative and avoidant coping throughout
gender transitioning. The Counseling Psychologist, 41(4), 601-647.
doi:10.1177/0011000011432753
Durso, L.E., & Gates, G.J. (2012). Serving Our Youth: Findings from a National Survey of Service Providers
Working with Lesbian, Gay, Bisexual, and Transgender Youth who are Homeless or At Risk of
Becoming Homeless. Los Angeles: The Williams Institute with True Colors Fund and The Palette
Fund.
Resources (continued)
Grafsky, E. L. (2014). Becoming the Parent of a GLB Son or Daughter. Journal of GLBT Family Studies, 10(12), 36–57. doi:10.1080/1550428X.2014.857240.
Johnson, M. J., & Amella, E. J. (2014). Isolation of lesbian, gay, bisexual and transgender youth: A
dimensional concept analysis. Journal Of Advanced Nursing, 70(3), 523-532.
doi:10.1111/jan.12212.
Ryan, C., (2009). Supportive families, healthy children: Helping families with lesbian, gay, bisexual &
transgender children. San Francisco, CA: Family Acceptance Project, Marian Wright
Edelman
Institute, San Francisco State University
Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in
adolescence and the health of LGBT young adults. Journal Of Child And Adolescent
Psychiatric Nursing, 23(4), 205-213. doi:10.1111/j.1744-6171.2010.00246.x
Savin-Williams, R. C., & Dubé, E. M. (1998). Parental Reactions to Their Child's Disclosure of a
Gay/Lesbian Identity. Family Relations, 47(1), 7–13. doi:10.2307/584845
Singh, A. A., Meng, S. E., & Hansen, A. W. (2014). 'I am my own gender': Resilience strategies of trans
youth. Journal Of Counseling & Development, 92(2), 208-218. doi:10.1002/j.15566676.2014.00150.x
Resources (continued)
Snapp, S. D., Watson, R. J., Russell, S. T., Diaz, R. M., & Ryan, C. (2015). Social support networks for
LGBT young adults: Low cost strategies for positive adjustment. Family Relations: An
Interdisciplinary Journal Of Applied Family Studies, 64(3), 420-430. doi:10.1111/fare.12124
Sullivan, M., & Wodarski, J. S., (2002). Social Alienation in Gay Youth. Journal of Human Behavior in
the Social Environment, 5(2), 1-17. doi:10.1300/J137v05n01_01
Vanderburgh, R. (2009). Appropriate therapeutic care for families with pre-pubescent
transgender/gender-dissonant children. Child & Adolescent Social Work Journal, 26(2),
135-154. doi:10.1007/s10560-008-0158-5
Wilber, S., Ryan, C., & Marksamer, J. (2006). CWLA best practice guidelines: Serving LGBT youth in
out-of-home care. Washington, DC: Child Welfare League of America.