Positive social change is possible. It is often slow and halting, but it does happen. In the past decade, people who identify as lesbian, gay, bisexual and transgender (LGBT) have experienced some positive change regarding their human rights and societal attitudes.

As of this writing, 37 states and the District of Columbia have legalized gay marriage. The Supreme Court is set to hear several marriage equality cases later this year, and its decisions may result in legalized marriage in all 50 states. There is greater public acceptance of LGBT people as well. In addition, more and more public figures have emerged from the closet, and a greater number of TV shows no longer shy away from featuring LGBT characters. In 2014, Laverne Cox, a transgender actress, appeared on the cover of Time magazine.

Although the LGBT community and its allies can increasingly celebrate many victories, this is tempered somewhat by the recognition that the LGBT population continues to face substantial challenges throughout society. Thirteen states still refuse to legalize gay marriage, and some judicial interference has reared its head in states where gay marriage has already been legalized. LGBT youth still face significant harassment and violence, particularly in school environments. Individuals who are transgender still confront a steady stream of misunderstanding, prejudice and violence.

Clearly, society still has a long way to go. And that is why counselors play such a crucial role in advocating for the LGBT population, demonstrating acceptance and helping these individuals navigate the changes and challenges facing them today.

Youth at risk

The adolescent and teen years are often marked by turbulence as young people grapple with issues such as grades, dating and friendships, self-esteem, emotional challenges, and college and career choices. LGBT youth face these same challenges in school environments that are often hostile and, in some cases, unsafe.

In a 2013 survey, “The National School Climate,” conducted by the Gay, Lesbian & Straight Education Network, 55.5 percent of LGBT student respondents said they felt unsafe at their school because of their sexual orientation and 37.8 percent because of their gender expression. Almost one-third of respondents reported losing at least one full day of school in the previous month because they felt unsafe, and 10 percent said they had missed four or more days in the previous month.

The survey indicates that LGBT students have good reason to be afraid. Almost 75 percent of respondents had been verbally harassed (threatened or called names) because of their sexual orientation; more than 55 percent had experienced verbal harassment because of their gender expression. Physical violence is also a significant concern for LGBT students. According to the survey, 36.2 percent of respondents had been physically harassed (pushed or shoved) in the past year because of their sexual orientation and 22.7 percent because of their gender expression. The violence extends beyond harassment — 16.5 percent of those surveyed had been physically assaulted in the past year because of their sexual orientation and 11.4 percent because of their gender expression. Given these numbers, it is perhaps not surprising that many respondents said they avoided gender-restricted spaces such as bathrooms and locker rooms because they felt unsafe or uncomfortable. The majority of surveyed LGBT students said they avoided school functions and extracurricular activities because they felt unsafe or unwelcome.

In addition to a hostile school environment, LGBT youth may face a lack of support or even open opposition from their friends, family members and communities. This rejection can result in high levels of stress, anxiety, depression and suicidal ideation, says Ken Jackson, a member of both the American Counseling Association and the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC), a division of ACA. Jackson gave a presentation on “Group Counseling Queer Youth in a High School Setting: Reflections and Lessons From a Six-Year Process” at the ACA 2015 Conference & Expo in Orlando, Florida, this past March.

For the past seven years, Jackson, head counselor at Decatur High School in Decatur, Georgia, has run a weekly peer support group for students who identify as lesbian, gay, bisexual, transgender, queer or questioning. Students are made aware of the group at the beginning of the school year when they are given “advisory” sheets to fill out. These sheets allow students to register their interests in a number of groups available at the school. All students are required to turn in an advisory sheet, so students don’t have to be afraid of sticking out or calling attention to themselves. The sheet also contains instructions for students who would rather disclose their interests directly to a counselor, Jackson says. In addition, LGBT students sometimes find out about the group from friends or teachers.

Students can belong to the group for as long as they need to, but initially Jackson asks them to commit to a semester. After that, it is not uncommon for students to come in and out of the group as they feel the need, he says.

Group discussions center on a mix of topics, some of which Jackson sets and others that students bring up. Many times, he notes, the discussions aren’t directly related to being LGBT. Instead, they often center on issues that are common to all students, such as coping with the death of a loved one, dealing with a parent who drinks too much or experiencing problems with a friend. The difference, Jackson says, is that group members can discuss these and other problems in an atmosphere in which they don’t feel the need to hide who they are.

“It [the atmosphere] lets them know, ‘This part of my [identity] is OK to talk about too if I want to and it comes up. I don’t have to make the mental effort of … putting up a shield so that I don’t mention something inadvertently,’” Jackson explains.

Of course, group participants do sometimes choose to talk about issues related to being LGBT. Frequent topics include when (or whether) to come out to friends, dating (including where to find people to date), feeling judged for being LGBT and problems with self-esteem.

Jackson thinks that group therapy is a particularly effective environment for LGBT youth to explore these issues. For one thing, he says, group work offers a practical approach because a counselor can reach more students. But even more important are the peer support and opportunities to learn from others in the group, he says. For example, in the LGBT group, students learn how to relate to others and what it feels like to be completely accepted. In turn, Jackson says, this helps group members navigate the challenges of the outside world.

Through the years, Jackson has collected quantitative and qualitative data both pregroup and postgroup. For the quantitative data, he looks at students’ grade-point averages (GPAs) at the beginning of the year and then at the 30-week mark. Usually, he says, the GPAs don’t change, but he views this as a success. Rather than the decline in grades and attendance that often accompany the challenges inherent in being an LGBT student, participants in his group are typically able to maintain their grades. The qualitative data come from the feedback that participants provide about the issues they have been facing, the things they have learned and the parts of the group sessions they think have worked best for them.

Group members have ascribed multiple benefits to the group experience, including increased self-acceptance, confidence, coping skills and self-awareness. Participants have also reported being more open to relationships, other people and their own feelings. Group members also expressed relief at having a place to talk about issues that aren’t generally seen as socially acceptable. They felt more clarity regarding their personal identities, and many reported developing close friendships with fellow group members, Jackson says.

A toxic combination

Although a substantial amount of research has been devoted to the challenges that LGBT youth face, little is available on what actually works, notes Catherine Griffith, an ACA and ALGBTIC member whose dissertation focused on reducing suicidality in this population. “There are a lot of suggestions for best practices [for treating suicidality in LGBT youth] but not much supporting evidence,” she notes.

Suicide is the third-leading cause of death among adolescents, and the rate among LGBT youth is even higher, says Griffith, who is also a researcher and assistant professor in the Department of Student Development at the University of Massachusetts Amherst. She says LGBT youth are more likely to be targets of verbal and physical harassment and assault than are their non-LGBT peers. LGBT youth also have higher rates of peer isolation and hopelessness and often lack positive coping skills, she explains.

This toxic combination puts them at increased risk for suicide. Research has shown that LGBT youth are anywhere from two to seven times more likely than their non-LGBT peers to commit suicide.

In her dissertation, Griffith wanted to test an intervention that wouldn’t require a great deal of time or money to implement. Part of her inspiration came from watching videos from the It Gets Better Project. “I was struck by the idea of fostering hope as a solution to reducing suicidality,” she says.

Because of the barriers involved in working with minors, the subjects Griffith chose for her dissertation were 18–20 years old. She recruited participants by posting fliers in various locations and visiting local LGBT organizations.

Initially, Griffith thought that by virtue of being out of high school and perhaps living on their own, participants in this age group might not be experiencing as many problems as their younger LGBT counterparts. She quickly learned otherwise.

“I was surprised at the high levels of dysfunction,” she says. “People were really struggling. There were high clinical levels of suicidality and a lot of drug use and isolation — just a lot of deep dark things they were coping with.”

Griffith’s study involved an eight-week, randomized intervention. Although all of the recruited participants received help, to achieve randomization, half were put on a waiting list and the other half were placed in groups immediately. Participants were placed in groups of eight to 10 and met weekly for 45 to 60 minutes.

Griffith designed a structured curriculum, “It Gets Better: A Group Experience for LGBTQ,” that was divided into two parts — learning positive coping skills and building hope. “The first session was really focused on getting to know one another’s stories,” she says. This helped participants break the ice, while also allowing Griffith to take stock of what coping skills the participants were using and whether those coping skills were positive or negative. Sessions two through five focused on positive coping skills such as deep breathing and free writing.

Participants also learned about positive reframing, a technique that made Griffith nervous at first. “I wanted to tread carefully,” she says. “There is a lot of positive research [on positive reframing], but how could we approach positive reframing without undermining their experiences and without making participants feel that we’re saying their problems are not problems?” When participants were surveyed at the end of the study, Griffith was both surprised and relieved to find that reframing was perceived not as a negative but rather as one of the most helpful techniques.

Sessions six and seven focused on hope building. Activities included “flipping the coin,” which involved writing down something negative that, when looked at another way, could be perceived as positive.

Another activity was “letter from a future you,” in which participants were asked to write themselves a letter from an older, kinder self. Although this “self” could be from whatever point in the future the participants chose, it had to be a time when they could imagine that things had gotten much better in society and for them personally. Their future selves would be strong and confident and have the support of friends and family members. While envisioning this scenario, participants considered what advice their future selves might provide. After writing their letters, participants shared them with the group.

Griffith says the letters benefited the participants in several ways. First, the act of envisioning a better tomorrow was valuable because it helped to build hope. Sharing the letters was also very powerful because the participants could voice their hopes and hear the hopes of others. “It was very poignant and valuable to share and hear others’ stories,” Griffith says.

In addition, participants had created a valuable resource they could return to during times when they were feeling low or discouraged. By rereading their letters, they could remind themselves of the positive advice their future selves had provided to them.

All of the discussion and activities helped participants realize that because of the things they had been through, they were stronger — and more empathetic — than they previously realized, Griffith says.

In many cases, participants shared stories that they felt would help others, including one participant who had gone through a particularly difficult coming-out process with his family. He acknowledge that the process had been painful but said that after his family finally accepted him, he realized he had actually grown much closer to them through the experience. In struggling to come to terms with his identity, the family had engaged in numerous in-depth conversations, and he felt this had deepened his emotional connection to them. He had chosen to move past the hurt and hold on to the positives that had emerged from the experience, Griffith says.

Griffith’s groups also watched a short documentary, Always My Son, made by the Family Acceptance Project. It recounts the story of a son who, when he comes out, is initially rejected by his father. The film then focuses on how the family worked through the negativity and pain and eventually arrived at a place where not only is the father accepting of the son, but the family also hosts get-togethers for people who are going through the same types of challenges.

“I think focusing on the potential for the family environment to get better is huge,” Griffith emphasizes. “The difference between thinking there is a zero percent chance that my family will accept me as I am versus thinking there is a 10 percent chance is huge. It’s not even a huge increase in hope, but it makes suicidality go way down. For me, that is a huge finding.”

The eighth and final session was devoted to saying goodbye and reviewing progress. The group’s reflections yielded another significant finding — the overall impact that a relatively brief intervention such as this eight-week program could have on suicidality. Griffith had hoped that the program’s participants might gain some valuable skills from the project, but she was pleasantly surprised at how well it actually worked.

“What I found was that it was really effective in terms of increasing hope and coping skills and in decreasing negative coping skills,” she says. “It [the change] was not just statistically significant but also practically significant.”

Griffith hopes other counselors will consider using the program and its curriculum (interested counselors can email Griffith at cagriffith@umass.edu for more information).

“[I] wanted an intervention that school counselors would be comfortable taking up and implementing,” she says. She adds that although teaching coping skills is an important part of the intervention, the social support that the intervention provides is even more critical.

Intervening at institutional levels

One of the most effective ways of helping LGBT students is to work toward enacting change on an institutional level, says Colleen Logan, a past president of ACA and the program coordinator for the marriage, couple and family counseling program at Walden University.

Logan, who is also a past president of ALGBTIC, works with school administrators and counselors to help implement zero-tolerance bullying policies and establish affirmative environments. She starts with a simple concept: Each child gets to go to school in a nonhostile environment.

Logan is of course working with counselors, teachers and school administrators to enact more comprehensive changes, but that premise of ensuring a nonhostile environment is a starting point on which most everyone can agree, she says. “Even that [basic change] would make a difference,” she emphasizes.

A nonhostile environment is a place where violence isn’t tolerated, and neither is name-calling or the use of phrases such as “That’s so gay,” Logan notes. “Think about the sexual minority youth, about what his or her experience is every day at school,” she says. “[He or she is] trying to navigate friendships, develop positive self-regard and self-esteem, and trying to negotiate romantic relationships in the face of all this prejudice.”

Logan wants all school staff to become aware that sexual minority youth are watching everything they do. In the process, their actions — or lack thereof — send a message. That message can be negative and hostile, or it can be affirmative.

Logan also believes that counselors have a responsibility to lead the way in spreading an affirmative message and combating prejudice. “It’s our ethical, personal and moral obligation,” she asserts. “It’s part of who we are as counselors to educate for equality and social justice.”

This can include everything from educating others and modeling appropriate actions to providing a safe space for LGBT students, Logan says. For instance, counselors can indicate that their offices are a safe space for these students by taking simple actions such as displaying rainbow or “Safe Space, No Hate” stickers.

Jackson agrees that counselors need to lead the way. “It’s our job as counselors to go beyond what is in our offices, and it’s our job to affect the school environment,” he says.

Jackson says counselors should fight for three major objectives in schools:

1) Establishing a gay/straight alliance organization

2) Developing a harassment policy that specifically mentions sexual orientation and gender identity

3) Putting in place a network of “safe” adults or advocates within the school

Jackson also urges counselors to identify their own biases and preconceptions so they can set them aside and be empathetic and supportive of LGBT youth. Counselors should also make sure they are competent in LGBT issues, he says.

“ALGBTIC has some great competencies for counseling transgender students or clients, as well as lesbian, gay or bisexual students and clients,” Jackson says.

For better or for worse

As more states legalize same-sex marriage, many LGBT couples are embracing an option that some thought they’d never have: the right to marry the person they love. Still, the ability to marry poses challenges — some that are familiar to all couples and others that are unique to same-sex couples. Counselors can play a vital role in helping clients navigate these issues.

It is not uncommon for two LGBT partners in a relationship to be at different stages of the coming-out process, and when considering marriage, that is a significant issue, says Joy Whitman, a past president of ALGBTIC and its current representative to the ACA Governing Council. “I’ve worked with a lot of couples in different stages, and it can pose multiple challenges,” she says.

Whitman, a licensed clinical professional counselor who has a practice in Chicago and is also a core faculty member in the counselor education and supervision program at Walden University, has helped couples determine what marriage — and the couple’s level of being “out” — will mean for them at work and as a family. In part, this involves giving deep consideration to several questions: How out do they want to be as a couple? How out are they currently as individuals? Are they already out to their respective family members? What will they tell their co-workers?

Whitman guides couples through the process of answering these questions and reconciling their different degrees of being out. To do this, she has to learn each person’s underlying reasoning. “The one [partner] who doesn’t come out may have some shame that we need to work through,” Whitman says, “or they might just be a more private person.”

Whitman then helps couples negotiate their differences. For instance, she might ask the partner who is most out to discuss specific situations in which he or she finds it particularly important, or most wishes, for the other partner to also be out. “You can’t always open up the closet all at once,” she says. “Sometimes, you have to work with the person who wants to go faster to slow down. It can take time, but the couple does get a deeper understanding of each other. It can really strengthen their relationship.”

What — or whether — to tell family members about the marriage is another area in which counselors can provide support and guidance to LGBT couples. Despite growing acceptance in society, the reality is that marriage brings with it a level of acknowledgment of “outness” that some family members may not be ready to handle.

Whitman had one client whose mother asked her not to invite their cousins to the wedding because the mother didn’t want them to know. In cases such as this, Whitman advises counselors to help their clients grieve and process any sense of loss before the wedding. That way, when the day arrives, they can focus not on who isn’t there to share this life event with them but who is.

In some cases, however, people anticipate the worst without truly needing to. “‘I can’t come out to my grandmother. It will kill her,’” Whitman cites as an example of something a client might say. “But that’s not necessarily true. Counselors can help [clients] decide what’s realistic. Is their fear going to be true? How can you be prepared for that reaction? How can you present this [the marriage] as a good thing?”

Practitioners may also need to counsel clients to practice patience with others’ reactions to their impending marriage. Sometimes families just need time to process the news, Whitman says. “If you’re coming out for the first time, it’s a lot [to take in],” she says. “You’re not just gay but getting married.”

After helping clients process their decision to get married, counselors can provide support in clients coping with the planning, Whitman says. For instance, clients might encounter vendors or members of the clergy who are not supportive of their marriage, and that can be uncomfortable. She advises counselors to talk with clients about their plans and prepare them to anticipate some possible pushback.

Finally, LGBT clients sometimes get overwhelmed as they prepare for the wedding and assume these feelings are connected to being gay. In reality, it is the type of emotion that all couples encounter, and counselors can help LGBT clients sort through that, Whitman says.

When identities intersect

When LGBT people are also people of color, the prejudice they experience is often amplified. They become potential targets of discrimination not only because of their ethnic or racial identities but also because of their sexual or gender identities.

Being a minority comes with feelings of marginalization that, when combined with regular threats of violence and harassment, create a “synergistic” outcome, says Richmond Wynn, an ACA member and licensed mental health counselor in Jacksonville, Florida.

“It’s more than just the result of being an ethnic minority or just being a sexual [or gender] minority,” he says. “It’s more than one plus one equals two. [It’s] more like one plus one equals three or four.”

This tricky addition is a result of discrimination being piled on discrimination and, in some cases, a feeling of rejection from one or more communities, says Wynn, an ALGBTIC member who is also an assistant professor at the University of North Florida.

For instance, LGBT persons of color may have grown up viewing their ethnic communities as a kind of sanctuary because everyone there knows what it is like to experience ethnic or racial prejudice. When those individuals then experience prejudice because they are LGBT, they may turn to their ethnic communities as a safety net. If those communities then reject them because of their LGBT status, their safe haven may be gone, Wynn explains. Conversely, because a person is LGBT and a person of color, he or she may not feel completely welcome or comfortable within an LGBT community, he says. Regardless, the intersection of a person’s multiple minority identities is many layered, says Wynn, adding that the amplified stress and daily challenges pose a significant risk to the person’s health and well-being.

“Research has shown an increased health disparity [in those with intersecting identities],” confirms Anneliese Singh, an ACA and ALGBTIC member who studies transgender resilience and LGBT mental health. “If you have another identity that protects against disparity, you don’t experience as many consequences. For instance, if you are a white gay man experiencing homophobia but you have a high income and access to more resources, there are less health disparities. But trans people of color have some of the highest health disparities — everything from low income, living in poverty, difficulty accessing mental health care and high rates of homelessness to hate crimes and other verbal violence.”

These disparities — a lack of resources and increased stressors — put LGBT people of color at high risk for physical and mental health problems. However, Singh and Wynn agree that despite the disparities and amplified marginalization, this conflict of intersecting identities can also be used to help build resilience.

Singh, who is also an associate professor at the University of Georgia, says some of her research has shown that transgender people may actually build resilience by the simultaneous development of a strong racial identification and a strong gender identification. By embracing both of their identities, transgender people are connected to both communities, which means additional sources of support, she explains.

“[Counselors] have to have a multifaceted approach to identity,” Singh says. “You have to look at what those intersections are. You can’t just assess gender, sexuality, race, religion. You need to try to understand what it is like [for example] to be an African American transgender person.”

By understanding clients’ identities and how they feel marginalized, counselors can better help clients find resilience factors that work for them, Wynn explains. “While it’s important to make sure that we understand how people are negatively impacted, it could also be used for the positive,” he says. “Counselors should look for [resilience] in the stories that clients tell us. We want to be aware so that we can highlight the areas of their stories that show resilience.”

“If they don’t occur organically in conversation,” he continues, “it’s reasonable to ask if there have been times when they have come out of an incident and felt stronger because of it — more energized or challenged.”

Wynn believes all clients can also build resilience in the face of truly horrible incidents. “Something simple I might ask is: How did you survive this? How are you sitting here today? How have you managed up until now? Because if they’re still here, they have been managing somehow,” he says.

In taking this approach, Wynn says that he is not asking clients to discount the incidents they have experienced. Rather, he is encouraging them not to become saturated with them but to instead draw strength from their experiences.

Wynn and Singh both emphasize that counselors working with LGBT people of color — or any LGBT client for that matter — must have a firm grasp of multicultural and LGBT competencies. Counselors should also self-evaluate to identify their own biases and the ways in which they feel marginalized, Wynn says. Taking that step will help sensitize counselors to what their clients are experiencing, he concludes.

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Additional guidance

The Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA, was founded in 1975 under the name Caucus of Gay Counselors. Members of ALGBTIC advocate for greater awareness and understanding of lesbian, gay, bisexual and transgender (LGBT) issues among members of the counseling profession and related helping occupations.

For further reading:

• Casebook for Counseling Lesbian, Gay, Bisexual and Transgender Persons and Their Families, edited by Sari H. Dworkin and Mark Pope, published by ACA, 2012
• Group Counseling With LGBTQI Persons, by Kristopher M. Goodrich and Melissa Luke, published by ACA, 2015

 

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To contact the individuals interviewed for this article, email:

• Catherine Griffith at cagriffith@umass.edu
• Ken Jackson at kjackson@uga.edu
• Colleen Logan at drcrlogan@gmail.com
• Anneliese Singh at asingh@uga.edu
• Joy Whitman at joy.whitman@waldenu.edu
• Richmond Wynn at rwynn@unf.edu

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org