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Chapter 1: Best Practices with Lesbian, Gay & Bisexual Youth and Their Families, Updated 1st Edition (Mandatory) [3 CE Hours] 1 The purpose of this course is to provide human services and mental and behavioral health professionals with definitional information, historical and sociopolitical frameworks impacting the lives of LGB youth, as well as the influences of community and family contexts. THIS COURSE FULFILLS THE REQUIREMENT FOR CULTURAL DIVERSITY/SOCIAL JUSTICE Chapter 2: Evidence-Based Implicit Bias Implications for Physicians and Healthcare Professionals (Mandatory) [1 CE Hour] 19 The purpose of this course is to provide a historical context of race and racism and its relationship to the development of racial implicit bias. The development of implicit bias will be discussed along with research demonstrating the impact of implicit bias on the clinical encounter. Recommendations for mitigating implicit bias are offered. THIS COURSE FULFILLS THE REQUIREMENT FOR CULTURAL DIVERSITY/SOCIAL JUSTICE Chapter 3: Laws, Regulations, and Ethics for California Psychologists (Mandatory) [4 CE Hours] 26 This course provides a summary review of current California laws and Board of Psychology rules which affect the practice of psychology. The course reviews the current version of the APA Ethical Principles of Psychologists and Code of Conduct and how it applies to the ethical practice of psychology. Several models for ethical decision-making are examined to assist the psychologist in choosing a course of action when an ethical dilemma arises. THIS COURSE FULFILLS THE REQUIREMENT FOR CALIFORNIA LAWS AND ETHICS Chapter 4: Suicide Risk Assessment and Prevention in Youth and Adults in California (Mandatory) [6 CE Hours] 46 This course will cover the etiology and risk factors for suicidal behavior, outline important assessment, intervention and prevention programs, and inform effective mental health treatment to help individuals develop and maintain a healthy perspective on life. The course will review research and literature concerning the scope of the problem, identification of high-risk groups, evidence-based prevention, and programs for delivering care and mental health treatment. THIS COURSE FULFILLS THE REQUIREMENT FOR SUICIDE PREVENTION TRAINING
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PSYCHOLOGY CONTINUING EDUCATION
Book Code: PYCA1423
Chapter 1: Best Practices with Lesbian, Gay & Bisexual Youth and Their Families, Updated 1st Edition (Mandatory) 3 CE Hours
Release Date: March 26, 2019 Expiration Date: March 31, 2024 Upon successful completion of this course, continuing education hours will be awarded as follows: Social Workers and Psychologists: 3 Hours Professional Counselors: 3 Hours
Faculty Author:
in Greensburg, PA, as an assistant professor since 2004 and as its program director since 2009. Dr. Harvey received her MSW in 1996 and her PhD in marriage and family therapy in 2007, both from Syracuse University in Syracuse, NY. In addition to her academic appointments, Dr. Harvey has had more than 15 years of clinical experience, including as a family therapist, support group facilitator, crisis counselor, and health education coordinator. She maintains private family therapy practices in Beverly, MA, Syracuse, NY, and Greensburg, PA. Dr. Harvey has written extensively and presented throughout the United States, Canada, and Mexico on topics related to sexual identity, sexual health, and gay and lesbian youth. Rebecca G. Harvey has no significant financial or other conflicts of interest pertaining to this course. Behavioral Health Planner: Lys Hunt, MSW, LICSW The planner who worked on this continuing education activity have disclosed that they have no significant financial or other conflicts of interest pertaining to this course. objectives as a method to enhance individualized learning and material retention. ● Provide required personal information and payment information. ● Complete the mandatory Course Evaluation. ● Print your Certificate of Completion. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.
Mitchell Rosenwald, PhD, LCSW, is an associate professor of social work at Barry University in Miami Shores, FL. He received his MSW and PhD in social work from the University of Maryland at Baltimore, his MA in sociology from Syracuse University in Syracuse, NY, and his BA in sociology and economics from Salisbury University in Salisbury, MD. Dr. Rosenwald has worked with children and families and co-facilitated youth groups for lesbian, gay, bisexual, and transgender youth. He has presented on key issues in adolescent development for this population and his publication topics include practice with the LGBT population in child welfare settings and psychotherapy groups. He is the co- author of Advocating for Children in Foster and Kinship Care. Mitchell Rosenwald has disclosed that he has no significant financial or other conflicts of interest pertaining to this course book. Content Editor: Rebecca G. Harvey, PhD , has been affiliated with the Marriage and Family Therapy Program at Seton Hill University How to receive credit ● Read the entire course online or in print. ● Depending on your state requirements you will be asked to complete: ○ A mandatory test (a passing score of 75 percent is required). Test questions link content to learning Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative Disclosures Resolution of conflict of interest
to diagnostic and treatment options of a specific patient’s medical condition.
©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. INTRODUCTION Learning objectives After completing this course, the learner will be able to:
Differentiate the family therapy models used with LGB youth and their families. Identify additional interventions for LGB youth and their families.
Discuss lesbian, gay, and bisexual (LGB) youth development. Explain contemporary challenges facing LGB youth and their families. Course overview While lesbian, gay, and bisexual (LGB) youth have always existed, it is only within the past few decades that their visibility
as a population, and a fuller exploration into their development, have been the focus of psychological and social inquiry.
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Gathering prevalence information is fraught with difficulty; however, many behavioral health and healthcare professionals in the United States, knowingly or unknowingly, have or are likely to encounter LGB youth and their families in their practice. These professionals are in a unique position to help these youth and their families through the various transitions and other issues that they may encounter. Indeed, research suggests that the more these families accept their children, the better off the children will be in their health and well-being (Ryan & Diaz, 2011). This basic-level course begins its exploration of this youth population with a definition of terms, a model of identity development, and a focus on diversity considerations. The course then discusses four major areas that affect LGB youth in their development as adolescents. Because issues facing any adolescent are commonly also family issues, particular focus is paid to interventions from a family systems perspective, including an in-depth exploration of three models of family Understanding youth sexual orientation Although lesbian, gay, and bisexual (LGB) youth have always existed in the population, in the past few decades there has been a significant increase in the visibility of LGB adolescents. Counting the number of LGB youth in the United States is a particular challenge because responses to survey questions on sexual orientation tend to underreport LGB identity and the populations surveyed tend not to be nationally representative; moreover, youth may indeed not come out with LGB identification in adolescence. However, it is helpful to have some “ballpark” statistics to know that the chance of a professional working with an LGB youth is not only quite possible but also very probable. According to the American Academy of Pediatrics (AAP), up to 10% of the population may be lesbian, gay, or bisexual (AAP, 2014). It is very likely that there are many more youth who will question their identification and ultimately “come out” who are also not counted in surveys. Given this reality, it is vital that families provide stability and support for these youth as they develop their sexual orientation. Indeed, it is essential that practitioners help families identify supportive measures that optimize outcomes, as well as reject behaviors that can result in poor health and mental health outcomes for the youth (Ryan & Diaz, 2011). Origins of sexual orientation A common question is why someone is lesbian or gay. Of course, asking this question illuminates a larger question as to why someone is interested in the origins of a homosexual or bisexual orientation – after all, individuals tend not to ask about why someone is heterosexual. Nonetheless, the latest research suggests that a number of factors may be responsible for determining sexual orientation. The American Academy of Pediatrics believes sexual orientation is fixed and is created by a combination of factors, including genetic predisposition (AAP, 2014). Summing up the research, the American Psychological Association (APA; 2008) states: There is no consensus among scientists about the exact reasons that an individual develops a heterosexual, bisexual, gay, or lesbian orientation. Although much research has examined the possible genetic, hormonal, developmental, social, and cultural influences on sexual orientation, no findings have emerged that permit scientists to conclude that sexual orientation is determined by any particular factor or factors. Many think that nature and nurture both play complex roles; most people experience little or no sense of choice about their sexual orientation (APA, 2008, p. 2). In summary, it is important to recognize that there are probably many reasons for a person’s sexual orientation, and research in this area continues. It is also important to emphasize that an LGB sexual orientation is not pathological but, instead, is reflective of human variance. It is vital for practitioners to know that focusing
therapy (structural, solution-focused, and narrative) that can be applied to work with LGB youth and their families. The purpose of this course is to provide current information on issues and dynamics that affect LGB youth and their families, as well as best practices for working with this population. The target audience for this course is behavioral health and healthcare professionals, including psychiatric-mental health nurses, social workers, mental health counselors, marriage and family therapists, and psychologists; however, other professionals who interact with LGB youth will find this course useful. After successfully completing this course, the learner will have an increased knowledge and understanding of the LGB youth population, the issues that LGB youth face, and specific models of family and other interventions that may be used in working with these youth and their families. It is hoped that this course inspires practitioners to pursue advanced knowledge and skills that will strengthen their interventions with this population.
LGB YOUTH DEVELOPMENT
on why youth (and adults) are LGB might be interesting, but distracts from the larger goal of assisting them with normative development. Definitions It is important to begin with a clear understanding of definitions, which have caused confusion among professionals. Sexual orientation is the romantic/emotional and sexual attraction and affiliation that an individual experiences toward another. Heterosexual orientation (attraction to the opposite sex) has historically been perceived to be the only “normal” sexual orientation; however, as norms have changed and the American Psychological Association removed “homosexuality” from its Diagnostic and Statistical Manual of Mental Disorders, Second Revision (DSM-II) , list of psychological disorders in 1973 (and other mental health and medical associations followed suit), homosexual and bisexual sexual orientations have increasingly been seen as legitimate and genuine alternatives. As the terms associated with sexual orientation are reviewed, it is important for clinicians to keep in mind that as youth begin, and continue, their process of self-realization with respect to sexual orientation, the youth’s self- identification may develop in ways that are more flexible or fluid, and less rigid, than some of these terms indicate. Therefore, sexual minority is an umbrella term that can apply to this population of youth who are in the process of exploring and defining their sexual orientation that is outside of heterosexuality. Clinicians should be aware of this fluid self-identification process and be mindful of not being too rigid when helping youth and families work with the following labels. It is also important for clinicians to be mindful and think beyond the word “sexual” (which is part of the common terminology of sexual orientation and sexual minority ) when working with this population. This means that a youth’s attraction and behavior toward another person has emotional and romantic components as well, which are very important dynamics to assess and address in the clinical setting. Lesbian is a term some females use to describe their sexual orientation and attraction to other females, while gay is a term used by many males and some women to describe their same-sex sexual orientation and attraction. Bisexual is a term used by some individuals to describe their sexual orientation and attraction to both sexes. Bisexuality for some may be a step in the process on the way to recognizing her or his sexual orientation, or it may be the final recognition of identity itself for a person whose sexual orientation extends to individuals of both sexes. Heterosexism is a term that refers to the social belief that the world is and should be heterosexual. Heterosexism in the United States is presented in various forms, from the current federal restriction on the definition of “marriage” as between
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a woman and a man (in the Defense of Marriage Act) to popular love songs and Valentine’s Day greeting cards offering only heterosexual options. Heterosexism is the pervasive yet sometimes subtle social view or force that reinforces heterosexuality as the only “normal” and therefore “acceptable” sexual orientation; this force becomes very important to LGB youth, as this course will later discuss. Homophobia is prejudice and/or discrimination toward individuals based on their perceived or actual sexual orientation. Such homophobia is grounded ultimately in fear of this social subgroup and it reinforces heterosexism at the societal level. A number of issues that LGB youth experience relate to coming of age in a world where homophobia is still fairly pervasive and threatens their well-being and sense of safety. Internalized homophobia is an intrapsychic barrier and a task to be surmounted by youth who are coming to terms with their uncertainty or shame about their LGB identity. The closet is the dynamic in which homophobia or internalized homophobia prevents an individual from recognizing her or his nonheterosexual orientation. Coming out is the process by which an individual acknowledges to himself or herself, and to the people in their lives, that they are not heterosexual. It is important to note that they may also identify as questioning or queer , or choose not to identify. Assuming any one of the “labels” that have been discussed in this section is an extremely complex process. It is during this important process that behavioral health professionals can often be helpful, although the youth’s journey and self-identification likely began long before discussing it with anyone. While this course focuses on youth with LGB sexual orientations and their families, it is important to note that the concept of gender identity is, at times, confused with sexual orientation. Gender identity is separate from sexual orientation and refers to an individual’s internal sense of femaleness or maleness (which encompasses any gendered thought and/or behavior). Individuals who feel that their sense of gender “matches” their biological sex can be referred to as cisgender . Conversely, individuals who feel some incongruence with the sex with which they were born and with their inner sense of maleness or femaleness may identify with the opposite gender. This is referred to under the umbrella term of transgender , commonly abbreviated as “T” (Mallon, in press). Individuals who are transgender express their gender identity in a variety of ways, including occasionally dressing as a member of the opposite gender, living as a member of the opposite gender, and sometimes physically changing their anatomy through an operation or operations. Gender identity issues are largely misunderstood by society, and this lack of understanding has led some people to alienate and feel hateful toward youth who are transgender. Transgender individuals can also face prejudice and/or discrimination called transphobia .
The development of gender identity and sexual orientation may at times overlap. A youth may articulate gender identity concerns (“I should have been a girl”), which during the development process can continue into a transgender identity but may also often transition into an LGB sexual orientation. It is important for clinicians to remember that although these concepts are related and overlapping, they are distinct. Not all individuals who are transgender are LGB, and not all LGB people are transgender. One’s inner sense of maleness or femaleness is quite different from the object of one’s romantic or sexual attraction. Although these two groups often share an experience of being stigmatized because their life experiences are challenging to traditional notions of gender, sex, and sexuality (and this may create affinity), these two groups are in fact so different that some LGB individuals exhibit prejudice toward those who are transgender. The reason that individuals who are LGB and those who are transgender are considered together is more for increased visibility in society and the advancement of civil rights than because of any other affiliation. LGB youth and individuals in general will identify as lesbian, gay, or bisexual; however, others may identify as questioning or queer (Q). Thus, when this population is referred to with a Q in the label, it pertains to questioning – in which case the youth is wondering about his or her sexual orientation but has not come to a conclusion, or queer – in which case the youth is using, through reclaiming, a previously homophobic term. Still other youth wish not to identify with any of these labels because they perceive sexual orientation as being fluid. One of the most important and difficult issues for sexual minority youth is that they must develop a healthy identity in the midst of great stigma. Therefore, the difference between how they label themselves versus how others label them is an integral part of this process of healthy development. The uses of Q can be meaningful because youth eventually get to claim or reject labels as they see fit. One of the most fundamental and powerful things a professional can do for youth is to create a space where they are allowed to explore identity without forcing any labels. At times the clinician might also encounter the acronym “LGBTQQIS.” Aside from the aforementioned definitions, the I refers to intersex (youth who are born with genitalia of both genders and are typically raised as females), and the S refers to straight (heterosexual allies – those heterosexual individuals who advocate for greater acceptance for this population). From a cultural perspective, some males, particularly in African American and Hispanic communities, might state they are on the “down low” and, while having same-sex behavior with males, do not identify as gay or bisexual. Finally, Two Spirit is a term specific to the Native American community in which some individuals believe they are born with and thus embody both genders. Table 1 presents, for reference, some of the core definitions that have been described.
Table 1: Definitions Bisexual ("B")
A term used by some individuals to describe their sexual orientation and attraction to both sexes.
Cisgender
A term used to describe individuals who feel some congruence with the gender with which they were born (assigned gender) and their inner sense of maleness or femaleness. The process by which individuals acknowledge to themselves and to the people in their lives that they are lesbian, gay, or bisexual. They may also identify as questioning or queer, or choose not to identify. A term used by many males to describe their sexual orientation and attraction to other males. Some females also utilize this word.
Coming Out
Gay ("G")
Gender Identity Heterosexism
An individual's internal sense of femaleness or maleness.
The pervasive yet sometimes subtle social view or force that reinforces heterosexuality as the only "normal" and therefore "acceptable" sexual orientation.
Heterosexual
Individuals whose sexual orientation is attraction to the opposite sex.
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Table 1: Definitions Homophobia
Prejudice and/or discrimination toward individuals based on their perceived or actual sexual orientation.
Internalized Homophobia Intersex ("I") Lesbian ("L") Queer ("Q")
An intrapsychic barrier and a task to be surmounted by youth who are coming to terms with their uncertainty or shame over their LGB identity.
Youth who are born with genitalia of both genders and are typically raised as females.
A term some females use to describe their sexual orientation and attraction to other females.
A term some individuals use to identify a nonheterosexual identity. This reclaims a previously homophobic term. Questioning ("Q") A term used by an individual who wonders about her or his sexual orientation but has not come to a conclusion. Sexual Orientation The romantic/emotional and sexual attraction and affiliation that an individual experiences toward another. The Closet The dynamic in which homophobia or internalized homophobia prevents an individual from recognizing her or his nonheterosexual orientation. Transgender ("T") A term used to describe individuals who feel incongruence with the gender with which they were born (assigned gender) and their inner sense of maleness or femaleness. The person innately identifies with the opposite gender. Transphobia Prejudice and/or discrimination directed toward transgender individuals. LGB youth identity development
Adolescence – specifically early adolescence, on which this course will focus – is the developmental period between the ages of 12 and 18 (Newman & Newman, 2015). In this period, youth “[confront] a new psychosocial conflict, in which pressures to ally oneself with specific groups and to learn to be comfortable functioning as a member of a group are major preoccupations. This conflict is called group identity versus alienation ” (Newman & Newman, 2015, p. 365). While this normative task applies to all youth, it is complicated by the reality that LGB youth face an additional developmental task that is unique to their population; this task addresses the need to accept a nonheterosexual sexual orientation in a social context that, although showing signs of easing, is still replete with heterosexism and homophobia. Although a central limitation of any model is that there cannot be a “one size fits all” application, the following model does present some core considerations that can assist practitioners in understanding and empathizing with LGB youth. Models of LGB identity development A classic model of identity development among LGB youth is Troiden’s model (Troiden, 1989). The first stage is sensitization , in which children might have an experience or experiences that provide beginning awareness that they may be different, but they likely lack the understanding to describe or articulate this to themselves or to others. The second stage is identity confusion , in which a youth is increasingly aware that he or she is not heterosexual. During this stage the youth begins to become aware of and directly face pervasive stigma, heterosexism, and his or her own internalized homophobia. Because of this, it can be very difficult for the youth to acknowledge an LGB sexual orientation. It might be safer to avoid, conceal, or even reimagine past same-sex behaviors. The third stage is identity assumption . In this stage, youth begin to feel more comfortable in taking on a nontraditional sexual orientation. Often they have created a space in which to begin safely exploring and questioning whether they could in fact begin to identify as LGB. The final stage is commitment . In this stage, internalized homophobia has decreased as the youth continues to feel more comfortable integrating a lesbian, gay, or bisexual identity with his or her self-concept. Here, the individual is able to come out to self and others to the extent he or she chooses (Troiden, 1989).
Table 2 presents the model of homosexual identity development that can be applied to LGB youth and has possible application to bisexual identity development. Table 2: Stages of Homosexual Identity Development 1. Sensitization.
2. Identity Confusion. 3. Identity Assumption. 4. Commitment.
Note . From Troiden, R. R. (1989). The formation of homosexual identities. Journal of Homosexuality, 17 (1), 43-74. Consistent with more recent thinking on any stage model, identity development among LGB youth does not necessarily always proceed linearly through subsequent stages without returning to an earlier stage. Moreover, a caution regarding stage theory models is that they focus clinicians, families, and even youth themselves on individual factors and de-emphasize the contextual elements that have vital implications for the development of healthy sexual identities for LGB youth. For example, a youth might be approaching the final stage of commitment and yet, after being bullied at school for being out as a gay teen, the youth might believe that, for safety purposes, he might return to the closet of the identity confusion stage. Yet another youth might have such great social support and personal resiliency that she practically skips the identity confusion stage and commits to being lesbian. For others still, a commitment might be to a “queer” identity or no identity at all because some youth question the need and utility of categories of sexual orientation in the first place. Since the introduction of Troiden’s model of homosexual identity development (Troiden, 1989), further scholarship has provided additional insight. After reviewing a number of earlier theoretical models, in 2006 Margaret Rosario and colleagues concluded that: “[I]dentity formation consists of becoming aware of one’s unfolding sexual orientation, beginning to question whether one may be LGB, and exploring that emerging LGB identity by becoming involved in gay-related social and sexual activities” (Rosario, Schrimshaw, Hunter, & Braun, 2006, pp. 46-47).
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In their research, Rosario and her colleagues also found that two types of development occur: youth can maintain their sexual orientation over time from an earlier age, or they can more gradually change to another sexual orientation. For example, in their study, youth who identified as gay/lesbian and bisexual earlier in life were more likely to identify as only gay or lesbian when they were older, while those who exclusively identified as bisexual when younger were more likely to continue to identify as bisexual as they became older. Role of cultural diversity in identity development Aside from this general discussion of identity formation and development, LGB youth are not an otherwise uniform group. Cultural diversity is present within the whole of the human experience and its presence within the LGB youth population is no exception. The culturally diverse variables of gender, gender identity, race, and class are some additional factors affecting identity development that need to be considered. Ability, national origin, and religion are other such variables. It is well known that gender plays a highly significant part in the development of children and adolescents; females are expected to embody more feelings (be affect-oriented), whereas males are socialized to be more task-oriented. With LGB youth, the influence of gender on sexual orientation can play out such that it might be easier for girls to “come out” than boys because, for example, it is more acceptable in the United States to see women rather than men walking hand-in-hand and showing affection. In Rosario and colleagues’ 2006 study, female youth were more likely than male youth to identify as gay/lesbian. Race plays a very important role with regard to sexual orientation. Heterosexism is still pervasive in African- American and Latino communities. Youth of color may struggle to manage the stigma associated with holding two “minority” statuses – sexual orientation and race (Kuper, Coleman, & Mustanski, 2014). This is made more complicated by those who identify as “down low” (described earlier as a label that refers to an individual’s same-sex attraction and behavior without identification of being gay or bisexual; Kuper et al., 2014). Racism in the LGB community continues to exist (Balsam, Molina, Beadnell, Simoni, & Walters, 2011). The civil rights movement for LGB individuals has largely been a Caucasian endeavor. This does not mean that people of color have been completely ignored, but it is only in
recent years that LGB organizations have been making better efforts to include discussions of race. Finally, class is relevant, particularly in the context of access to supports. Kosciw, Greytak, and Diaz (2009) found that LGB youth who were poverty-stricken were less likely to have supportive school environments and more likely to encounter homophobia at school. Identity development is linked to social supports, and some of these social supports come at a cost. Because some LGB or questioning youth are concealing their identities from their families, they may be more self-reliant on their own funds to access social supports. For example, although smartphones and computers with Internet connections are commonplace, some individuals have limited or no access to such technologies due to their associated costs. Much social support for LGB youth is generated through Internet connections; therefore, not having full access to these potential supports might hinder identity development. To reduce the barriers of poverty and increase the numbers of youth who receive the benefits of social supports, many resources for LGB youth are purposely free of charge. However, even free supports have associated costs. Those youth with more means are more likely to have the finances to arrange transportation and pay other costs associated with attending LGB youth community meetings typically found in more urban regions. Those with fewer funds might again face difficulty obtaining this support and, even with means, this difficulty may be further compounded if these individuals live in rural areas (Leedy & Connolly, 2008). Identity development among LGB youth is a complex process. At its core, it is about an individual’s safe exploration, confusion and questioning, and commitment to an LGB sexual orientation. It is further complicated by the diversity of the youth involved based on gender, race, age, class, and other variables. The best practice for a practitioner is to have some familiarity with these developmental issues and processes, knowledge of the youth’s environmental context unique to his or her region (e.g., different school districts’ responses to LGB students), and associated supportive resources for LGB youth in the region. As always, the practitioner needs to begin with the client’s identification of goals he or she would like to achieve.
CONTEMPORARY CHALLENGES
Coming out Impact on youth
difficult to admit to themselves an LGB orientation. For example, the role of religion is complex and can present a very strong viewpoint that nonheterosexual orientation is immoral. However, in recent years, many religions and denominations have developed organizational subentities that are affirming of LGB individuals. Additionally, the role of family members can also be complex, and the degree to which a youth feels comfortable to come out is based in part on the family’s acceptance of the LGB sexual orientation. Sometimes youth will actually come out to relatives who are not their parents, saving the perceived most- difficult disclosure for last. Family response The response of the family, particularly the parents, is typically so central to a youth’s identity development that it can be a common issue when LGB or questioning youth and their families have family therapy, especially upon the youth’s coming out. Ideally, parents (or adult caregivers) showcase their unconditional love for their children and instantly embrace their child, regardless of any sexual orientation. Although this does occur sometimes and should be celebrated, it is common for even supportive parents and family members to experience a grieving process. Ironically, a youth’s coming out to parents commonly serves as a forced catalyst to the family’s own coming out process (their public acknowledgment that they have an LGB family member) and the sometimes sudden onset of grief in particular (Parents, Families and Friends of Lesbians and Gays
As described earlier, coming out refers to the process by which an individual consciously discloses to herself or himself, and to others, the identification that he or she is lesbian, bisexual, or gay. (Coming out can also refer to transgender acceptance.) Research shows that youth are coming out at younger ages, usually in the early-to mid- teen years. This is younger than in earlier cohorts and the trend shows that the age of coming out continues to get younger over time (Drasin et al., 2008). This occurs for a variety of reasons. The exponential growth in the use of the Internet and social networking has created instantaneous groups in which youth can build community. In- person communities, whether Gay/Straight Alliances (GSAs) in school and/or youth support groups affiliated with social service or mental health agencies are also on the rise. The increased presence of contemporary adult role models who are public about their identity and/or relationships, including NFL football player Michael Sam, U.S. Senator Tammy Baldwin, actors Neil Patrick Harris and Jodie Foster, and other celebrities, provide more positive images of adults who can be successful, adjusted, and open about being LGB. In addition, state regulations related to marriage equality have widened the national dialogue concerning discrimination based on sexual orientation in the media, schools, and communities. Nevertheless, certain factors also contribute to keeping youth in the closet or closeted – that is, forced to hide or even making it
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Book Code: PYCA1423
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[PFLAG], 2014). Of course, when a family comes out, they also do so in the context of heterosexism and homophobia as they currently exist in the larger society. Parents will often need to grieve that their children will not grow up and marry a person of the gender that the parents thought they would; their children may not have children (although plenty of LGB adults have their own children) or may have children in non-traditional ways; and the realization that they (the parents) will need to either hide their child’s LGB identity or come out to their own friends, other relatives, and so forth when one day asked why their child is not married (to the opposite gender). The challenges heterosexism and homophobia present regarding these tasks should be acknowledged and addressed as part of the family’s or parents’ own coming out process (Saltzburg, 2009). It should be noted that the above is applicable when a youth explicitly comes out. There are other situations in which, for many reasons, families might “suspect” for years (even into adulthood) that their children or siblings are LGB, including that they never date someone of the other gender and/or they have a close “companion” of the same sex. In these cases, the youth is at least partially closeted and, therefore, the family’s perception (which may not be confirmed) is that the youth is LGB. To show support, families can help normalize same-sex relationships by asking if their loved one has “someone special” in her or his life (instead of an assumed gender-specific role). Additionally, families can create an atmosphere of support by clarifying their affirming view of LGB people in general, discussing LGB people and lives in everyday conversation, including well-known personalities such as Ellen DeGeneres, and/or by viewing age-appropriate LGB characters and stories in the media (e.g., television programs such as Modern Family and Glee ), and affirming support of marriage equality or other issues of interest to the LGB community. Parents may learn of their own child’s LGB identification at the same time they learn their child is involved in a romantic relationship. Although sometimes the parents are instantly accepting of their child and their child’s girlfriend or boyfriend, often this information can be overwhelming. Whenever possible, parents and other relatives need to avoid the Tragically, individuals are still targeted for violence because they are gay, lesbian, or bisexual (as well as transgender). According to Federal Bureau of Investigation (FBI) statistics, 20.2% of reported hate crimes in 2013 were based on sexual orientation (FBI, 2014). While this percentage does not break down the age range of those who were victimized, it does depict a social reality in which LGB youth know that violence can occur and they need to be somewhat vigilant for their safety. In 2009, President Obama signed the Matthew Shepard and James Byrd, Jr., Hate Crimes Prevention Act, which expands federal definitions of hate crimes to include those related to sexual orientation (U.S. Department of Justice, n.d.). Violence also occurs in school in the form of bullying. According to the Human Rights Campaign, youth who are LGB (as well as transgender youth) are twice as likely to report being bullied in the forms of verbal harassment, physical assault, and online harassment (cyberbullying) as non-LGBT students (Human Rights Campaign [HRC], n.d.). Bullying takes place both in person and as cyberbullying through social media like Facebook and Myspace (HRC, 2011). This genuine fear of bullying and other violence can result in LGB youth avoiding school or having difficulties concentrating on their schoolwork because they are understandably concerned for their safety and avoiding harassment. In some schools, a common prevention/intervention for bullying is having “safe spaces” in school in which a student can report bullying behavior. In essence, the school administration should appropriately intervene without bias to address this form of bullying; however, the reality is that schools range widely in how aware of and concerned they are about the Violence and bullying Impact on youth
“exceptionalization” argument in which parents make an “exception” for their child being LGB. In other words, parents might accept their child being LGB because the child is “not like” other LGB individuals. Parents might cite their love for the child and/or the child’s adherence to gender conformity, which allows them to accept their child being LGB while still maintaining a homophobic stance toward other LGB individuals. When this attitude is pervasive, it can negatively affect the youth and her or his relationship as the parents accept their child but not the child’s boyfriend or girlfriend. In actuality, this indicates that the parents have not completely accepted their child’s LGB sexual orientation because, if they did, such acceptance would encompass all of the child’s life, including choice of relationship and the romantic partner as well. Many parents and other relatives gradually become more comfortable with having an LGB family member and can go through a self-reflective process that reminds them that the unconditional love they have for the youth will see their family through this “adjustment.” In these cases, family therapy as well as adjunct therapies can be extremely helpful. However, for other families, their grief process becomes stuck on anger, emotional abuse, physical abuse, and perhaps abandonment (where the youth is forced to leave the family home). Although such negative responses to stress may be temporary in some families, for others they serve as permanent wedges and cause a lifetime of estrangement. Unlike most other forms of prejudice where, for example, parents provide support for their children who are experiencing challenges associated with racism, LGB youth cannot always assume that their parents will be sources of support. Indeed, this support can vary and change so much over time that the safe anchor that parents typically provide for their children cannot be automatically assumed. What is clear is that parental rejection of a child who comes out increases that youth’s risks, whereas supportive parent-child relations better protect LGB youth from the challenges they face (Ryan & Diaz, 2011). Family therapy is therefore an increasingly important intervention for youth because even small improvements in family relations can be pivotal for their self-esteem and development. bullying of LGB students. This presents an additional challenge for students enduring bullying because they are identified as LGB. Fortunately, if “out” youth can forge ahead despite bullying at school, they can experience better long-term well- being (Russell, Toomey, Ryan, & Diaz, 2014). Finally, violence can at times occur in the home, where parents might physically abuse and/or neglect their children upon finding out they are LGB. Youth may either be forced to leave their homes or they choose to run away from a violent household. It is estimated that 15% to 30% of homeless youth are LGB (as well as questioning and transgender) and face major challenges of surviving on the streets, including survival sex, substance misuse, homophobia, suicide risk, and sexual exploitation (Rosario, Schrimshaw, & Hunter, 2012; Sherouse, 2015; Winter, Elze, Salzburg, & Rosenwald, in press). Federal programs are beginning to respond to the need to help this population (Winter et al., 2015). Family response The ideal family response is one of complete support. Parents and other relatives should create an atmosphere in which their children feel safe to report that they have been a victim of a hate crime or have been bullied at school. Youth who are not out to their parents may actively hide the fact that they are being bullied precisely because to disclose this would highlight that they are being targeted for their sexual orientation, which would risk outing them before they are ready. Most parents who are aware of their child’s LGB identity are very concerned about their children’s safety after they come out. They can take the lead in maintaining open lines of communication and periodically checking to see how safe their children feel in the school and the
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Book Code: PYCA1423
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