What are the key factors that need to be addressed when working with LGBTQ clients?
READINGS
Use your Diversity, Oppression, and Social Functioning text to read the following:
Chapter 11, “Lesbian, Gay, Bisexual, and Transgender People Confront Heterocentrism, Heterosexism, and Homophobia,” pages 162–182.
Use the Capella University Library to read the following:
Israel, T., Gorcheva, R., Walther, W. A., Sulzner, J. M., & Cohen, J. (2008). Therapists’ helpful and unhelpful situations with LGBT clients: An exploratory study. Professional Psychology: Research and Practice, 39(3), 361–368.
For this discussion, your fellow learners have created a presentation that contextualizes practice with the LGBTQ population. After you view their presentation, use your post to discuss one or more of the following in 250 words:
What are the key factors that need to be addressed when working with LGBTQ clients?
Discuss similarities and differences in the several groups contained within the LGBTQ community.
Are there similarities between any of these groups and the groups that you researched?
How would you incorporate the key factors into your plan for working with clients from these groups?
Requirements: 1PAGE
Chapter 11 Lesbian, Gay, Bisexual, and Transgender People Confront Heterocentrism, Heterosexism, and Homophobia
George A. Appleby
Human behavior surrounding sexuality, intimacy, affection, and identity is complex, and this complexity has to be acknowledged when dealing with sexual orientation. Even the words that are used to describe gay, lesbian, transgender, and bisexual identity are complicated and hotly debated. Many now reject, for example, the term sexual preference, once considered correct for describing gay, lesbian, or bisexual phenomena, because it seems to reduce a core identity or master status to a matter of taste, as if one likes tacos or spring rolls. The term sexual orientation, which is the one used in this chapter, is now generally preferred because it seems to suggest something more fundamental to the person than just a casual choice among equally available alternatives. The other term used here, sexual identity, emphasizes self-labeling, although it has both social and psychological components. However, sexual orientation can be seen as more stable than sexual identity, which may change over a person’s lifetime (Chung & Katayama, 1996). Just as gay, lesbian, and bisexual people must negotiate their social and psychological identity development in the context of a heterocentrist, homophobic, and heterosexist society, social work and other mental health professionals must develop their understanding of sexual orientation issues in a context that until recently viewed homosexuality as pathology in and of itself. It was only in 1973 that the American Psychiatric Association (APA), which sets the prevailing terms in the United States for classifying psychopathology through its Diagnostic and Statistical Manual, now in its fourth edition (APA, 1994), removed homosexuality from its list of psychiatric disorders. Thus anyone living with such identification or learning about mental health before that time had to deal with the prevailing psychiatric view of a homosexual sexual orientation as a mental illness. It is not surprising, therefore, that the remnants of that attitude are still commonly encountered in the professional context today, in professionals, in clients, in their families, and in the community (Appleby & Anastas, 1998).
The view of a gay, lesbian, or bisexual orientation as a form of psychopathology was gradually replaced by the idea that being lesbian or gay is a stable and fixed positive identity. Sexual orientation refers to a characteristic of an individual that describes the people he or she is drawn to for satisfying intimate affectional and sexual needs—people of the same gender, the opposite gender, or of both genders. We use the terms lesbian and gay in preference to homosexual to refer to men and women who are not heterosexual, or straight. In part, this is done because of the history of pathologizing attached to the term homosexual. In part, it is done because patterns of development and adaptation to a same-gender sexual orientation, like many other aspects of development, tend to differ somewhat between men and women. However, we sometimes use the term homosexual to refer to both genders together, especially to refer to specifically sexual phenomena. However, the term homosexual has been used in the past to refer only to males, so care must be taken in using the term not to render the experiences of women invisible (Garnets & Kimmel, 1993). However, the terms gay and lesbian are often used to refer to men and women who not only engage in same-gender sexual and/or affectional activities but who also adopt, to some degree or another, what is termed a homosexual lifestyle. Some object to this concept of lifestyle, too, because it may seem to trivialize what is a life by suggesting that it has elements of fashion to it. In fact, this discussion touches on the controversy about whether there is a gay or lesbian culture in the true sense of the term and about whether open participation in that culture is necessarily desirable for lesbians, gays, and bisexuals (Lukes & Land, 1990). This issue of culture was discussed in greater depth in Chapter 2.
The term sexual identity, which is increasingly emphasized in the literature, refers to self-labeling as lesbian, gay, or bisexual (Reiter, 1989). Because sexual behavior and self-labeling are often not consistent with each other, some have differentiated the concepts by noting that “identity changes [while] orientation endures” (Reiter, 1989, p. 138). Although sexual identity is usually experienced as psychological, or internal, it is also influenced by interpersonal, social, and cultural experience (Cox & Gallois, 1996).
While sexual orientation certainly involves sexuality, it is just as strongly related to affectional and social needs that are not just sexual. Gay, lesbian, or bisexual people who are not currently sexually active retain their basic sexual orientation, just as a heterosexual person does. In fact, viewing gay, lesbian, or bisexual people as overly sexualized or compulsively sexually active is one form that homophobia can take. Based on research findings and practice experience, we now know that sexual orientation is not just about sex and sexuality; it is about sexuality, emotionality, and social functioning. The development of a sexual identity represents the integration of all of these aspects of sexual orientation into a coherent whole, an authentic sense of self, with a self-label that is subjectively meaningful and manageable. Differences in sexual orientation are based on whether a person directs his or her sexual and intimate affectional feelings and behavior toward same-gender, opposite-gender, or both same-and opposite-gender others. Thus, some bisexual people explain their choice of love object as the result of finding specific personal qualities of the individuals they choose to relate intimately to as more important than the person’s gender (Weinberg, Williams, & Pryor, 1994; Eliason & Raheim, 1996). This conceptual definition suggests that sexual orientation should be assessed on multiple dimensions (Chung & Katayama, 1996).
The definition of sexual orientation that we have so far given is primarily a psychological one; that is, it is mental, affective or emotional, and behavioral. It has nothing to do with appearance and identifiability, because there is a great diversity in how gay, lesbian, and bisexual people look, how they present themselves, and thus how identifiable they may be. In fact, the great majority of gay, lesbian, and bisexual people are not visible or identifiable as such. Nor is any visible gay, lesbian, or bisexual community or subculture available or attractive to all gay, lesbian, and bisexual people. In fact, the formerly pejorative term queer has been adopted by some gay, lesbian, and bisexual activists to indicate a specific identification with and participation in the visible gay, lesbian, and bisexual culture and political movement that flourishes in some large cities and to distinguish a cultural and/or political commitment from sexual orientation itself.
Rubin (1984) observes that acceptable sexuality should be heterosexual, marital, monogamous, reproductive, and noncommercial (pp. 280–281). It should be coupled, relational, express itself within the same generation, and occur at home. It should not involve pornography, fetish objects, sex toys, or roles other than male and female. In most cultures, gay, lesbian, bisexual, and transgender people violate many of these rules.
Transgender people are the least studied and the most discriminated against of all sexual minorities. Cross dressing and gender blending have existed everywhere throughout human history. Despite anatomical differences between males and females, there is potential for considerable physiological and anatomical variation among individuals with the same sex organs and much overlap between the two genders. Bushong (1995) reminds us that one’s gender is on a continuum with most people at either end of the female to male scale, but a significant minority are somewhere in between. There are those whose gender does not match their physiological gender. A term used to characterize such individuals is gender dysphoria. As is the case with same-gender sexual orientation, gender dysphoria is not pathological, but a natural aberration that exists within the population. Estimates of the number of people with gender dysphoria vary, ranging from 1% to 3% of the population. Gender norms depend strongly on the time, location, and the history of a culture (Bornstein, 1994; Wilchins, 1997).
Transgender people have varying sexual orientations ranging from heterosexual to bisexual to homosexual. They also have varying degrees of discomfort with their physiological gender of birth. Bullough, Bullough, and Elias (1997) report equal numbers of male-to-female and female-to-male transsexuals. Some transsexuals identify themselves at a very early age, well before puberty, while others emerge in their retirement years. There appears to be a surge in coming out during the mid-life years when there is a reevaluation of one’s life. Generally speaking, transgender people fall into five primary groups:
1. Cross dresser (Transvestite): people who have a desire to dress and in general appear as members of the other gender. Most cross dressers are heterosexual men. Their sexual orientation has nothing to do with their cross dressing.
2. Transgenderist: people who avoid gender role extremes and tend to be androgynous. They often incorporate both female and male aspects into their appearance. They may live part of their lives as the other gender or a blend of both. They may live entirely in the other gender role but with no plans for genital surgery.
3. Transsexual: people whose gender identity most closely matches the other sex. These individuals often feel trapped in the body of their biological gender and long to rid themselves of their primary and secondary characteristics. They yearn to live as members of the other
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