Qualities that LGBT look for in their therapies

I mentioned early that clinical practitioners will soon and later encounter LGBT clients in their practice, so by then we should be adequate (at least general) LGBT knowledge to provide effective treatment. 

Other than the basic knowledge of LGBT issues, what other qualities that LGBT individuals will look for in their therapies?

Today I would share a interesting research done by state University of New York regarding the therapist qualities preferred by sexual-minority individuals. They enrolled 42 nonheterosexual adults in this research to examine the preferable qualities in therapist. Here are the key findings of the research:

1)  Undesirable, less favorable qualities or characteristics

1.      Reluctance to ask questions to ask questions about the individual's sexual identity or overemphasizes individual's sexual identity.

2.      Lacks awareness of LGBT issues.

3.      Fails to recognize individual may not be heterosexual.

4.      Use heterocentric language.

5.      Treats LGB individuals as other non-LGB clients and conceptualizes issues related to sexual orientation as similar to any other type of therapeutic problem.

Therapist with these qualities may have difficulty retaining and providing effective treatment to LGB client. Liddle (1996) research also report that therapists' heterocentric assumptions were found to five time more likely to increase in the likelihood of premature termination and to lowered ratings of counselor helpfulness.

2) Desirable or favorable qualities of characteristic

1.      LGB-specific knowledge

2.      Preferable of  LGB therapist depending on the presenting issues (coming-out process, sexual identity formation).

3.      LGB-affirming attitudes such as stance of openness towards LGB individuals and sexuality, supporting the individual in adopting a LGB identity when LGB clients have decided.

4.      Establish and maintain strong therapeutic alliances with clients.

Thus, participants generally valued therapists who had LGBT specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapist who held heterocentric views. So please remember to take the homophobic test as provided in my previous post to understand if you are too heterocentric or heterosexism. Please share with me your views on providing therapeutic services to LGBT clients as well if you have one. Based on my previous experience with non-heterosexual clients, I do agree with the findings that LGBT knowledge and non-heterocentric views are very essential in providing an effective treatment.

References

Burckell L. A. and Goldfried M. R. (2006). Therapist qualities preferred by sexual-minority individuals. Psychology: Theory, Research, Practice Training, 43(1), 32-49

Liddle, B. J. (1996). Therapist sexual orientation, gender, and counseling practices as they relate to ratings on helpfulness by gay and lesbian clients. Journal of Counseling Psychology, 43, 394-401.

Mental Health Services for LGBT

According to aforementioned posts regarding LGBT risk to mental health, we could see that LGBT people are more likely to use mental health services and to have sought advice from their GP for emotional difficulties. From my knowledge, LGBT friendly mental health services or facilities is an unheard news across Singapore and Malaysia, so I couldn't really comment on the service standards and do much research for this region.  

So, how about the  service standards of mental health facilities for LGBT in Western countries? Will unequal treatment exist? Research suggests mixed experience of mental health services ranging from excellent to extremely poor, including unhelpful reactions from mental health professional. (Glasgow Anti-Stigma Partnership, 2009).

Another research done by Cathleen et al (2006) regarding the mental health care for sexual and gender Minority Groups in a Rural  U.S. State also report that majority of rural  providers claimed that there is no difference between working with LGBT clients and non-LGBT clients.  Furthermore, despite   providers' claims of acceptance, lack of education about LGBT mental health issues, and homophobia influenced services for rural LGBT people, many LGBT clients had been denied services, discouraged from broaching sexuality and gender issues by providers, and isolated within residential treatment settings.

The little knowledge and understanding of how needs for care and support may be different for LGBT people may hinder LGBT individuals to seek mental health services early.  Stonewall Cymru (2009) reported that half of the LGBT participants delay seeking mental health services due to the anticipation of negative responses and poor service. Moreover, because of the anticipation of negative responses, many LGBT people might be reluctant to declare their sexual-orientation and true sexual identity to avoid discrimination and poor service.

Thus, an environment that acknowledges and respects difference and which enables the person to live as they wish become crucial in the support of the health care needs of  LGBT people. I wish I could see the development of LGBT friendly mental health services in Asia in the near future. It will be great if I could join this development as well :)

LGBT Ageing and health care support

Other than the mental health service, another crucial issue that we have to be concern will be the ageing of LGBT people and their needs for health care services during their senior years.

In 2006, there were as many as 3 million LGB seniors aged 65 and older in the United States, and this number is expected to grow to 4 million by 2030 (deVries et al., 2006). And this increasing number of aging people will be a global phenomena as well.

Unfortunately, senior LGBT individuals also can't avoid to be the victim of sexual prejudice and discrimination. A study of LGB individuals over the age of sixty reported almost two-thirds (63%) of the participants were the victim of verbal abuse based on their sexual orientation and more than a quarter (29%) received threats of physical violence. 29% of the LGB participants reported being victimized by someone who threatened to disclose their sexual orientation to friends, family, and co-workers (Grossman, D'Augelli, & O'Connell, 2001).

As studies have found that nursing home staff often report intolerant or condemning attitudes towards homosexual and bisexual residents (Cahill et al., 2000; Gross, 2007), social services and health care providers should be more aware of this emerging issues and strike to resolve this issue as soon as possible.

Fortunately, there are several solutions are emerging in United States. The first LGB retirement community , the Palms of Manasota is located in Sarasota, Florida, and Rainbow vision in  SantaFe, New Mexico, opened in 2006 (deVries et al., 2006). Moreover, it is anticipated that LGB retirement housing options will increase dramatically in coming years. For example, L.G.B.T. Aging Projects are springing up in Boston, New York, Chicago, Atlanta and other urban centers to train long-term care providers. At the same time, there is a move to separate care of LGBT clients from non-LGBT clients to promote the comfort of the familiar. In the Boston suburbs, the Chelsea Jewish Nursing Home will includes a unit for the gay and lesbian elderly and Stonewall Communities has begun selling homes designed for older gay people with support services similar to assisted-living centers. There are also openly gay geriatric case managers who can guide clients to compassionate services. (Gross, 2007).

 I am not sure how long it will take for Asia country to have such services, but I will definitely be pleased to witness such LGBT friendly services be booming in Asia.

References

Cahill, S. South, K. & Spade, J. (2000). Outing age: Public policy issues affecting gay, lesbian, bisexual and transgender elders. Washington, DC: National Gay and Lesbian Task Force.

Cathleen E. W., Melina Salvador M. & Miria (2006). Brief Reports: Unequal Treatment: Mental Health Care for Sexual and Gender Minority Groups in a Rural State. Psychiatric Services, 57, 6. Retrieved October 17, 2012, from http://ps.psychiatryonline.org/article.aspx?articleID=96789

deVries, B., Croghan, C., & Worman, T. (2006). Always independent, never alone: Serving the needs of gay and lesbian elders. Journal on Active Aging, 5, 44-47.

Glasgow Anti-Stigma Partnership (2009). There's more to me: A report on Lesbian, Gay, and Bisexual People's Beliefs, Attitudes and Experiences in Mental Health. Glasgow: Scottish Association for Mental Health

Gross, J. (2007, October 9). Aging and gay, and facing prejudice in twilight, New York Times. Retrieved  October 17, 2012, from http://www.nytimes.com/2007/10/09/us/09aged.html.

Grossman, A. H., D'Augelli, A. R. & O'Connell, T. S. (2001). Being lesbian, gay, bisexual, and over 60 or older in North America. Journal of Gay and Lesbian Social Services 13, 4, 23-40.

Stonewall Cymru (2009). Double Stigma: The Needs and Experiences of Lesbian, Gay and Bisexual people with Mental Health issues Living in Wales. Cardiff: Author.

Ward, R., Rivers Ian & Sutherland. M. (Eds.) (2012). Lesbian, Gay, Bisexual and Transgender Ageing: Biographical approaches for inclusive care and support. London, UK: Jessica Kingsley Publisher.

 

LGBT and Employment

Do you know?

This is discrimination against both lesbian and heterosexual women, aren't' they? Don't you think that our labor market is too patriarchy oriented?

References

Elmslie, B., & Tebaldi, E. (2007). Sexual orientation and labor market discrimination. Journal of Labor Research, 28(3), 436-453.

Peplau., L. A., & Fingerhut, A. (2004). The paradox of the lesbian worker. Journal of Social Issues, 60(4), 719-736.

Risk to Hate Crime

Aggression and attacks on LGBT people happen all around the world. If you have some free time, take a look of this film named "Boys Don't Cry " that vividly illustrating Gender Identity Disorder (GID) and the hate crime against transsexualism. It was disturbing to me when I saw hate crime scene in the film.  LGBT people should enjoy the human rights and freedom as we have, and we should all work hand-in-hand against hate crime, and bringing those hate crime perpetrators to justice.

1) In the study of a community sample of 342 LGBT individuals, 57.7 % of the lesbians reported having been a victim of either child sexual abuse and or adult sexual assault. (Heidt, Marx, & Gold, 2005)

2) Berrill (1992) reports that thousands of episodes - including defamation, harassment, intimidation, vandalism, assault, murder and other abuse have been reported to police departments and to local and national organization (NGLTF Policy Institute, 1991), while countless more incidents have gone unreported. Statistics on incidence of anti-gay violence show them to be on the increase throughout the United States (NCAVP, 2005).

3) In 2001, 2475 Americans reported being victimized by antigay violence, up to 10% from 2249 in 1999. In 2004, According to FBI, 15% of hate crimes were committed against people because of their perceived nonheterosexual orientation. FBI Uniform Crime Reporting Program indicate that 15.7% of the single bias reported in 2004 were sexual orientation bias, of those 1197 bias crimes, 13.7% were specifically anti-lesbian (Mallon, 2008).

4) A study of 400 self-identified lesbians in San Francisco fund that 84% had experienced verbal harassment, 40% had been threatened with violence, 27% had had objects thrown at them, and 12% had been punched, kicked, hit, or beaten (Von Schulthess, 1992).  

5) Study of 2669 transgender people in Europe state that 79% of respondents reported some form of harassment in public places ranging from comments to physical or sexual abuse. (Turner et al., 2009).

6) Transgender people are twice as likely to have been victims of physical violence and three time as likely to experience harassment as LGB people. (Browne & Lim, 2008).

7) The Scottish Transgender alliances studied on transgender people's experience of domestic abuse suggested that high level of domestic abuse with 80% of survey respondents reporting emotional, physical or sexual abuse from a current or former partner based on a rejection of their trans identity. (Roche et at., 2010).

Be a voice for LGBT civil and human rights!

References

Berrill. K (1992). Anti-gay violence and victimization in the United States: An overview. In G. Herek & K. Berrill (Eds.). Hate Crimes. Newbury Park, CA: Sage Publications.

Browne, K & Lim, J. (2008). Trans People: Additional Finding Report.Count me in Too: LGBT lives in Brighton and Hove. Brighton: Spectrum.

Heidt, J., Marx, B., & Gold, S. (2005). Sexual revictimatization among sexual minorities: A preliminary study. Journal of Traumatic Stress, 18(5), 533-540.

Mallon Gerald P. (2008). Social Work Practise with Lesbian, Gay, Bisexual, and Transgender People (2nd ed). New York: Routledge.

National Coalition of Antiviolence Programs (NCAVP) (2005). National information from the 2004 report on anti-lesbian, gay and transgender & bisexual violence, victimization and defamation in 1991. Washington, DC: National Lesbian/Gay Task Force.

Roche, A., Morton, J. and Ritchie, G. (2010). Out of Sight, Out of Mind?. Edinburgh: Scottish Transgender Alliance. Retrieved October 16, 2012, from http://www.scottishtrans.org/Uploads/Resources/trans_domestic_abuse.pdf

Turner, l., Whittle, S. & Combs, R. (2009). Transphobic hate crime in the European Union. Retrieved October 16, 2012 from http://www.ucu.org.uk/media/pdf/r/6/transphobic_hate_crime_in_eu.pdf

Von Schulthess, B. (1992). Violence in the streets: Anti-lesbian assault and harassment in San Francisco. In G. M. Herek & K. T. Berrill (Eds). Hate crimes: Confronting violence against lesbian and gay men (pp. 133-152). Newbury Park, CA: Sage Publications.

 

 

 

Sexual prejudice and discrimination towards LGBT youth

For LGBT youth, the impact of discrimination, harassment and violence can be worse. The emotional and physical turmoil many adolescents face as part of the maturation process can be further complicated in LGBT youth who struggle to construct their self-identity and role at this developmental stage (Identity crisis). 

1) Two million US teenagers were reported in 2001 as having serious problems in school because they were taunted with antigay slurs (Stepp, 2001, A1).

2) 84.3% of LGBT students reported hearing homophobic remarks using words such as faggot or dyke.

3) 90% reported frequently hearing the expression "that's so gay" or "you're so gay".

4) 86% of LGBT students were verbally harassed at school in the past year because of their sexual orientation; 67% were harassed because of their gender expression (acting “too masculine” or “too feminine”).

5) 68.6% of LGBTQ students reported feeling unsafe in school because of their sexual orientation

6) 80.6% of students reported there were no positive portrayals of LGBTQ people, history or events in classes.

 (Gay, Lesbian and Straight education network (GLSEN), 2003; GLSEN, 2009).

Seriously, an allies program that aim to facilitate LGBT youth building up their sexual identity and recognizing their sexual orientation need  to be developed in school especially in Asia countries. I have spent 17 years in school but I couldn't remember there was such program being established in school. Only till recent year I heard that there is school counselor in school (my friend who is the school counselor, and she is the only one that provide counseling services to the students and staff (approximately 700 students in her school). Can you believe that one counselor can handle all 700 students? 

References

Stepp, L. (2001). A lesson in cruelty: Anti-gay slurs common in school. The Washington Post, pp. A1, A7

GLSEN (2009). GLSEN Safe Space Kit: Guide to being an ally with LGBT students. Retrieved  Oct 16, 2012 from http://www.glsen.org/binary-data/GLSEN_ATTACHMENTS/file/000/000/294-10.pdf, pp. 1-48.

GLSEN (2003). GLSEN Safe Space: A how-to guide for starting an allies program, pp. 1-38. New York: Author

LGBT Risk to Mood Disoders and Anxiety Disoders

Many LGBT people suffer from symptoms of depression and anxiety due to a lifetime of discrimination and ridicule. It might be hard for us to imagine how discrimination and prejudice could engenders depression and anxiety, however, we should appreciate and understand the social stress that LGBT people face on top of the common stress we have in your workplace, school and family. There are many findings report that the vulnerability of  LGBT people of having mood disorder and anxiety disorder is much higher than heterosexual people.

1) A study done in 2011 by University of Michigan revealed that  discrimination, harassment and  internalized homonegativity are the main factor that explain depression and anxiety among black sexual minority men. 30% of the sample had a scale scores indicating likelihood of depression and anxiety (Graham et al., 2001).

2) Homosexual seniors who have not come out or come to terms with their sexual orientation may experience depression and isolation from the years of internalized homophobia (Altman, 2000).

3) Chronic low-grade depression is often the reason gay men seek therapeutic assistance. These symptoms can arise out of societal oppression and difficulties they face in the coming-out process. Long term symptoms of depression are masked by substance abuse and only emerge after the individual begins recovery from chemical dependency (Gonsiorek, 1982; Smith, 1988).

4) A research in U.S. based on 912 men who self-identified as both Latino and non-heterosexual showed high prevalence rates of psychological symptoms of distress in the population of gay Latino men during the 6 months before the interview, including suicidal ideation (17% prevalence), anxiety (44%), and depressed mood (80%). Experiences of social discrimination were strong predictors of psychological symptoms (Diaz et al., 2001).

5) In Conhran and Mays' study in 2000, lesbian women are more likely to experience generalized anxiety disorder (GAD) than their heterosexual female counterparts.

6) Homosexual and bisexual individuals are more frequently than heterosexual persons reported both lifetime and day-to-day experiences with discrimination. Approximately 42% attributed this to their sexual orientation, in whole or part. Perceived discrimination was positively associated with both harmful effects on quality of life and indicators of psychiatric morbidity (depression, anxiety disorder, substance abuse, panic disorder) in the total sample(Mays & Cochran, 2001).

7) People with GID often experience anxiety or depression and may have thoughts of suicide (Doctor & Neff, 2001; Bradley. 1995). Anxiety and depression might be the reactions that related to the confusion and pain brought on by the disorder itself, but they may also be tied to the prejudice typically experienced by individuals in daily basis.

I found this interesting picture and I would like to share with you :0

 

Picture link: http://25.media.tumblr.com/tumblr_mbg31rCqsb1qk1b4io1_1280.jpg

 

 

References

Altman, C. (2000). Gay and lesbian seniors: Unique challenges of coming out in later life. SIECUS Report, 4, 14.

Bradley, S. J. (1995).Psychosexual disorders in adolescence. In J. M. Oldham & M. B. Riba (Eds.), American Psychiatric Press review of psychiatry, (Vol. 14). Washington, DC: American Psychiatric Press.

Cochran, S.D, & Mays, V. M. (2000). Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population. American Journal of Epidemiology , 151(5), 516-523.

Mays, V. M. & Cochran, S. D (2001). Mental Health Correlates of Perceived Discrimination Among Lesbian, Gay, and Bisexual Adults in the United States. American Journal of Public Health, 91(11), 1869–1876.

 

Díaz RM, Ayala G, Bein E, Henne J & Marin BV. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. American Journal of Public Health, 91(6), 927-32.

Doctor, R.M., Neff, B. (2001). Sexual Disorders. In H. S. Friedman (Ed.), Specialty articles from the encyclopedia of mental health. San Diego: Academic Press.

Graham LF, Aronson RE, Nichols T, Stephens CF, Rhodes SD. (2011). Factors Influencing Depression and Anxiety among Black sexual Minority Men. Retrieved October 12, 2012 from http://www.ncbi.nlm.nih.gov/pubmed/21941644

Gonsiorek, J. (1982). The use of diagnostic concepts in working with gay and lesbian populations. Journal of Homosexuality, 7, 9-20.

LGBT Risk to Suicide

Sadly, most of my LGBT friends did think of or attempt suicide when they were facing stress with disclosure or during the coming out process.  It might be rather easy for  heterosexual people to share their love relationship conflict with their significant others and seek advice from them. However,  for LGBT people, due to the sexual stigmatization, majority of them keep their relationship conflict or problem within themselves and hardly express their emotional pain. The hopelessness and helplessness might be the key elucidation of suicidal thoughts and attempt. Here are some research about the LGBT risk to suicidal ideation:

1) A large-scale UK study which compared the mental health of 1,093 heterosexual with 1,284 LGBT people, almost a third of the LGBT people had attempted suicide (King et al., 2003).

2) Research suggest that lesbian are at greater risk for attempting and completing suicide than heterosexual woman. One study of adults found that lesbians were significantly more likely to have considered suicide in the past than heterosexual women, with over half of the lesbians having contemplated suicide (51%), compared to 38% of heterosexual women (Hughes et al., 2000).

3) National lesbian health Care survey (NLHCS) found that over half their lesbian sample had thought about suicide, with 18 % having attempted suicide (Bradford et al., 1997).

4) The  Boston Lesbian health Project II showed that 20% of their sample had made a suicide attempt (Roberts et al., 2004).

5) Between 48% and 76% of homosexual and bisexual youth have thoughts of committing suicide, and 29% to 42% have attempted it, compared with estimated rates of 7% to 13% among high school students in general (Armesto, 2001; Cochran & Mays, 2000; Russell & Joner, 2001).

 

There is always hope, please do not keep this suicidal feelings to yourself, share with someone you trust (at least make a call), it could your friends, parents, family members or counsellor, and let them know how bad things are. Don’t let fear, shame, or embarrassment prevent you from seeking help. Just talking about how you got to this point in your life can release a lot of the pressure that’s building up and help you find a way to cope.

There a few hotlines or organization you could seek help or make call for: Let someone know your pain.

1) Samaritans organization worldwide:

Hong Kong : http://www.samaritans.org.hk - 24/7 hotline: 2896 0000

United States : http://www.samaritansusa.org

Samaritans of Singapore (SOS) : 24/7 hotline: 1800-221 4444

United Kingdom : http://www.samaritansusa.org : 24/7 hotline: 08457 90 90 90

2) USA national suicide hotline http://www.suicidehotlines.com/ 1800-SUICIDE :1-800-784-2433

References

Armesto, J.C. (2001). Attributions and emotional reactions to the identity disclosure of a homosexual child. Family Process, 40(2), 145-162.

Bradford, J., Ryan, C., & Rothblum, E. (1997). National lesbian health care surveys. Implications for mental health care. Journal of Lesbian Studies, I(2), 217-249.

Bradley, S. J. (1995).Psychosexual disorders in adolescence. In J. M. Oldham & M. B. Riba (Eds.), American Psychiatric Press review of psychiatry, (Vol. 14). Washington, DC: American Psychiatric Press.

Cochran, S.D, & Mays, V. M. (2000). Lifetime prevalence of suicide symptom and affective disorder among men reporting samesex sexual partners: Results from NHANES III. American Journal of Public Health, (90)4, 573-578.

Hoare, J. and Moon, D. (Ed.) (2010) Drug Misuse Declared: Findings from the 2009/10 British Crime Survey. Home Office Statistical Bulletin 13/10. Retrieved October 17, from  http://www.homeoffice.gov.uk/rds/pdfs10/hosb1310.pdf

 

Hughes, T.L., Haas, A., Razzano, L., Matthews, A.K., & Cassidy, R.(2000). Comparing lesbians' and heterosexual women's mental health: Findings from a multi-site study. Journal of Gay & Lesbian Social Services, 11, 57-76.

King, M., McKeown, E., Warner, J., Ramsay, A., Johson, K. & Cort, C. (2003). Mental health and quality of life of gay men and lesbian in England and Wales: controlled, cross sectional study. British Journal of Psychiatry, 183, 552-8.

Roberts, S., Grindel, C., Patsdaughter, C. Reardon K., & Tarmina, M. (2004). Mental health problems and use of services of lesbian: Results of the Boston Lesbian Health Project II. Journal of Gay & Lesbian Social Services, 17(4), 1-16.

Russell, S. T., & Jorner, K (2001). Adolescent sexual orientation and suicide risk: Evidence from a natural study. American Journal of Public Health, 91(8), 1276-1282.