Working Clinically with the LGBT

Community: First Steps

Lola White, Psy.D.
 Using our words

 Homosexual / Queer
 Cisgender and Transgender
 Passing / Blending
Cisgender
Cissexual
Transgender
Transsexual
Sexual Orientation/Gender Identity may not
be the presenting problem

 Do not over-treat or under-treat their sexuality

 Do not assume that sexual orientation/gender identity is the
presenting problem
 Do not assume that it has no impact on their mental health
 Helping a Client decide about Coming
Out

 Evaluate possibility for negative reactions

 rejection, harassment, discrimination, anti-LGBTQ violence
 Evaluate possible gains
 feeling more authentic, not having to hide a major part of
oneself, increase of intimacy via self-disclosure/sharing of life
events, receiving support, finding community, consolidating
identity
 Explore: internalized transphobia, homophobia, sexism,
consequences of bending traditional gender roles, loss of
acceptance, and lack of societal support

From Coming Out: Considerations and clinical implications. Sixto Muñoz, LICSW
Anthony D’Augelli: “Homosexual
Lifespan Development Model”

D'Augelli, A.R. (1994). “Identity development and sexual orientation:

Toward a model of lesbian, gay, and bisexual development.”
Lev – Transgender Awareness Model
Exploration
(Transition
Issues &
Awareness Exploration Possible
(Identity and Body
Self-labeling) Modification
)

Integration
Seeking Disclosure to (Acceptance
Info/Reaching Significant & Post-
Out Others Transition
Issues)

Lev, A.I. (2004). Transgender Emergence: Therapeutic guidelines for working with gende
variant people and their families. Binghamton, NY: Haworth Press.
Sexual Orientation Microaggressions in Therapy
or Supervision
 Shelton & Delgado-Romero (2011) found several prominent
themes
 Assumption that sexual orientation is the case of all presenting
issues
 Avoidance and minimizing of sexual orientation
 Attempts to overidentify with LGBQ clients
 Making stereotypical assumptions
 Expressions of heteronormative bias
 Assuming LGBT folks need psych treatment
 Warnings about the dangers of identifying as LGBT
Sexual Orientation Microaggressions in Therapy
or Supervision

 Consider what it means to a client to have only

heteronormative magazines available in the waiting
area
 Or an intake packet with relationship options listed as
“single, married or divorced”
 Or what how it sounds to a client to have their sexual
orientation assumed rather than asked
 Denial and Resistance
 Revisiting Privilege
 The position of feeling entitled to define someone else’s
experience, regardless of their input.
 It also encourages the privileged to behave as less than adults,
i.e. acting hurt or put upon when confronted with
microaggressions
 Blaming the Victim
 Accusing the other of being “hypersensitive”
 Confusing Impact and Intent
 “I didn’t mean it that way”
 Undoing
 Denial and Resistance
 A key aspect to this conversation is parsing out INTENT from
IMPACT
 As previously noted, microaggressions largely do NOT involve a
conscious harmful or malicious intent
 Even well-meaning people can impact others in a negative way
 The key to resolving microaggressions is not in exerting
privilege, but acknowledging it
 Resources
 Brill, S. (2008). The Transgender Child: A Handbook for Families and Professionals. Cleis Press.
 Cass, V. C. (1979). Homosexual identity formation: A theoretical model. Journal of Homosexuality, 4, 219-235.
 D'Augelli, A.R. (1994). “Identity development and sexual orientation: Toward a model of lesbian, gay, and bisexual development.”
 Diplacido, J. (1998). Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and
stigmatization. In G. Herek (Ed.), Psychological Perspectives on Lesbian and Gay Issues: Stigma and sexual orientation: Understanding prejudice
against lesbians, gay men, and bisexuals. (pp. 138-160). Thousand Oaks, CA: SAGE Publications, Inc. doi:
http://dx.doi.org/10.4135/9781452243818.n7
 Lev, A.I. (2004). Transgender Emergence: Therapeutic guidelines for working with gender-variant people and their families. Binghamton, NY:
Haworth Press.
 Spiegel, A. (2002, January 22). 81 Words. Retrieved from http://www.thisamericanlife.org/radio-archives/episode/204/81-words
 Shelton, K. & Delgado-Romero, E.A. (2011). Sexual orientation microaggressions: The experience of lesbian, gay, bisexual, and queer clients in
psychotherapy. American Psychological Association, 58(2), 210-221.
 Smith, L.C., Shin, R.Q., & Officer, L.M. (2012). Moving counseling forward on LGB and transgender issues: Speaking queerly on discourses and
microaggressions. The Counseling Psychologist, 40(3), 385-408.
 Oregon Trans Health (includes an updated listing of trans-friendly OHP providers): http://oregontranshealth.com/
 Salem Transgender Network: http://www.salemtg.net/
 National Transgender Discrimination Survey Report on health and health care: http://
www.thetaskforce.org/static_html/downloads/reports/reports/ntds_report_on_health.pdf
 National Healthcare for the Homeless Council report on Gender Minority & Homelessness: Transgender Population:
http://www.nhchc.org/wp-content/uploads/2014/10/in-focus_transgender_sep2014_final.pdf
 Transgender Law Center: http://transgenderlawcenter.org/
 World Professional Association for Transgender Health: http://www.wpath.org/
 https://safezone.uncc.edu/allies/theories
 http://www.hrc.org/resources/resource-guide-to-coming-out
 http://www.itgetsbetter.org/
 http://www.rucomingout.com/