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Counseling Gay, Lesbian, Bisexual and Transgendered Individuals

Homosexuality is defined as sexual attraction to a person of the same sex (Sue & Sue, 2008). Because gay, lesbian, bisexual and transgender (GLBT) individuals are reluctant to identify themselves it is difficult to get an accurate estimates of their numbers. Sue and Sue (2008) estimate that approximately 4-10 percent of the U.S. population is homosexual.

It is impossible to describe a unified reality that fits every GLBT individual because within this large and diverse group there are multiple realities (Brown, 1989). The experience of each individual within this group is different depending on ethnic group, religious background, age, degree of “outness”, and gender. Even within this group there are divisions and hierarchies.

According to one bisexual person:
Transgendered people are the second-class citizens, and bisexuals are below even them. We’re the white trash of the gay world, a group whom it is socially acceptable not to accept. Feeling awkward among straight is what it feels like to be bi. Being distrusted among gays is what it feels like too. (as cited in Sue & Sue, 2008)

Gay, lesbian, bisexual and transgendered individuals are often viewed as a threat to the structure of society and face anger, threats, and hostility each day, often in the name of God (Deeb-Sossa & Kane, 2007).

Issues in Counseling Gay, Lesbian, Bisexual and Transgendered Clients
Gay, Lesbian, Bisexual and Transgendered individuals face many of the same issues as heterosexuals including: depression, low self-esteem, physical or sexual abuse, and difficulties with relationships and careers (Brown, 1989; Sue & Sue 2008). In addition, GLBT individuals also face issues that are associated with their sexual minority status. As a sexual minority GLBT individuals still face discrimination and hostility (Frost & Meyer, 2009; Herek, Gillis, & Cogan, 2009). Gays and lesbians are more than twice as likely as heterosexuals to experience sexual abuse as adults. They are also at higher risk for Major Depression, Generalized Anxiety Disorder and substance and alcohol related problems (Sue & Sue, 2008). While the American Psychiatric Association has removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM) many therapists continue to see homosexuality as a mental illness (Sue & Sue, 2008). Gender identity issues and cross-dressing are still included in the DSM (American Psychiatric Association, 2000). Kirk and Belovics (2008) explored some of the unique issues faced by transgender individuals including discrimination in hiring practices and problems with supervisors over how to dress and which restroom to use.

Many of the problems that bring GLBT individuals into counseling are the result of internalizing society’s negative view of homosexuality (Herek, et al. 2009; Sue and Sue, 2008). The term sexual stigma refers to the negative regard and inferior status that society places on anyone not associated with heterosexual activities and relationships (Herek, et al. 2009; Frost & Meyer, 2009). According to Herek et al. (2009) Heterosexuality is viewed as the norm, and children are socialized to believe that everyone is heterosexual (the “heterosexual assumption”) and that they will grow up to be heterosexual. As a result sexual minorities are viewed as abnormal, unnatural and inferior (Brown, 1989). Gay, lesbian, bisexual and transgender individuals grow up with these messages and they become internalized and lead to negative feelings toward themselves and other GLBT individuals. Frost and Meyer (2009) showed that there is a strong correlation between internalized homophobia and relationship problems among GLBT couples.

The issue of “coming out” is another problem unique to the GLBT population. Unlike many other minority groups that may find a sense of belonging with their shared racial or ethnic background within their family circle, GLBT individuals are often ostracized by their family of origin or find it necessary to hide their sexual orientation from those to whom they are closest (Sue & Sue, 2008). The revelation of sexual orientation is often met with anger, grief or guilt. It is the role of the counselor to help the client decide to whom and how to come out, and to help them find support among their family, friends or community after coming out.

As in working with any person or couple in therapy it is important to see GLBT clients first and foremost as unique individuals. Counselors need to be aware of their personal beliefs and biases when working with GLBT clients and avoid focusing on sexual orientation when it is not necessary (Brown, 1989; Mohr, Weiner, Chopp, & Wong, 2009; Sue & Sue, 2008; Williams, 2005). Mohr et al. (2009) found that “client bisexuality had a strong effect on judgments regarding the relevance of clinical issues that were related to bisexual stereotypes but not directly related to the presenting problem” (p. 172).

Many of the mental health issues faced by GLBT individuals are the result of internalizing society’s negative messages about homosexuality (Herek, et al., 2009). By challenging society’s assumptions about gender and gender roles feminist therapy provides a framework for exploring the sources of internalized stigma and bias. Feminist counselors also work to depathologize traits that have historically been associated with women and are therefore seen as undesirable (Corey, 2009). This can be extremely beneficial in helping clients to see themselves in a positive light instead of as mentally ill.

Feminist Theory
Unlike many other theories feminist theory does not have a single founder, but is the result of decades of scholarly conversation and collaboration among women across many disciplines from politics to religion (Corey, 2009; Walters, 2005). According to Walters (2005) women began to speak for themselves and their sex as early as the 1600s. The consciousness raising groups of the 1960s led to changes in the way female therapists practiced (Corey, 2009). Feminist therapy moved from what Williams (2005) described as the eurocentric counseling therapies that held white, middle-class, heterosexual men as the norm and equated mental health with the masculine traits of individualism, independence, and autonomy, to a more egalitarian form of counseling that valued women’s experiences and looked at the way women were constrained by traditional female roles (Corey, 2009).

In the 1970s the “second wave” of feminism attempted to unite all these ideas into a set of philosophies of feminism: liberal, cultural, radical and socialist feminist (Corey, 2009; Walters, 2005). The prominent feminists of the 1970s tended to be white, middle-class and heterosexual and were criticized for excluding the voices of women of color, sexual minorities and women of lower socioeconomic status (Calhoun, 2000). In response, contemporary feminism, embraces diversity and attempts to be more culturally sensitive and inclusive of all women, including lesbians (Corey, 2009).

Feminist Therapy and the Gay, Lesbian, Bisexual and Transgender Client
Although it has traditionally focused on women and women’s issues feminist therapy is appropriate for exploring many of the issues facing GLBT individuals. Through techniques such as gender-role analysis, gender-role intervention and power analysis, feminist therapists help clients to recognize how they have internalized society’s negative messages about gender and the way they have been socialized into gender-roles. They work with their clients to understand how sexist and oppressive beliefs affect them in negative ways (Corey, 2009). In exploring how gender-roles are the result of socialization gay, lesbian, bisexual and transgender individuals become free to explore their own heterosexual biases and to determine that they have the freedom to define themselves and their identity as “man” or “woman” in ways that are more authentic and beneficial (Brown, 1989; Calhoun, 2000).

A basic tenet of feminist theory is “the personal is political” (Corey, 2009). One of the main goals of feminist therapy is to help clients become empowered to change the sociopolitical environment that has historically oppressed them. Calhoun (2000) cautions against assuming the political agenda for GLBT individuals is the same as for white, heterosexual women. Marriage, which has historically been an institution of subordination for women, should be viewed as empowering GLBT individuals. It not only grants access to material and social benefits, but is also the core normative institution around which society is based. To bar sexual minorities from this institution is displace them from entering fully into society.

Brown (1989) argues that feminist therapy can be accused of being heterosexist as it still relies on defining people according to the labels “women” and “men” and doesn’t take into account the unique experiences and traits of GLBT individuals, the “third sex”. She proposes a new paradigm that includes the unique experiences of lesbians and gays. Like many biracial individuals gay and lesbians are able to pass as members of the dominant culture and may disown parts of themselves or others that don’t fit with cultural ideals. Counselors need to be sensitive to this issue and help their clients to be comfortable with expressing the full range of their identity and experience.

As a minority group GLBT individuals face discrimination and violence and are not allowed to participate fully in society (Calhoun, 2000). A feminist framework can be very effective in counseling GLBT individuals by challenging the negative messages about sexual orientation and gender roles they have internalized from society, by empowering them to take personal and social action, and by allowing them to explore ways to live authentically.

This paper has touched on only a few of the issues counselors may face in working with GLBT individuals. This group is made up of many unique individuals with a wide range of backgrounds and experiences and a variety of issues they wish to work on in counseling. They also share common issues as a result of their sexual minority status. While these issues are complex, it is important for counselors to treat each client as a person first, and to be sensitive to the culture and experiences of each client.

Counselors should use their experience and knowledge to understand the issues their client’s bring into the therapeutic relationship and to discern whether sexual orientation has any bearing on the issues presented. In order to work effectively with GLBT clients it is necessary for counselors to examine their own personal biases and gender socialization process. It is also important that they respect the needs of each client, and avoid pushing their personal feminist agenda on any client (Corey, 2009).

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