Psychological Supports for LGBT Youth & Young Adults: Where We’ve Been and New Initiatives
Laura M. I. Saunders, Psy.D. Lsaunde@harthosp.org Richard Stillson, Ph.D. Richard.stillson@po.state.ct.us
Today
• Action plan to take back to schools/programs • Developmental perspective on the Coming Out process • Impact of homonegativity on GLBT youth who struggle with mental illness • Nurturing alternative families • Community Efforts in CT • Future directions/interventions/recommendations
Gender vs. Sexual Orientation
Gender is a combination of one’s Birth sex Gender role Gender identity Sexual orientation encompasses: Sexual Attraction Sexual Identity Sexual Behavior
Internalized Homophobia vs. Homo-negativity
• The irrational fear of homosexuals and homosexuality • Negative perceptions of homosexuality internalized by persons w/ a same sex orientation (Rosser, et al., 2008) • Herek (1996) argued that this is a principal social factor impacting on queer mental and sexual health • Also referred to as Sexual Identity Distress
Identity formation- Sexual Orientation
• Gay/lesbian/bisexual identity development (Cooley, 1998) • 4 Adjustment/phases
– Sensitization – discovering same sex feelings of attraction – Identity confusion – reacting to same sex attraction – Identity assumption – discovering/accepting same sex attraction – Commitment – adopting glb identity
Identity Formation – Gender Variance
• Developmental Stages -One to two years of age- become conscious of
physical differences between boys and girls -By age 3 – can identify self as boy or girl -By age 4- gender identity is stable and, in typical development, congruent with biological sex -Entering kindergarten – gender identity is well established
Perspective of SO & GV –the last 20 years
• How has the process of exploring one’s sexual orientation and gender variance changed over the last 20 years? -Regional differences -By identification/label -Role of the internet -Age of coming out
Jackson, R. (2008)
Jackson, R. (2008)
Jackson, R. (2008)
Age of Coming Out - 1996
• Girls aware of attraction to same gender: age 10 • First same-sex experience at age 15 • Boys first awareness of attraction to same gender: age 9 • First same-sex experiences at age 13 • Identification as glb began around age 16 for both genders
Herdt & Boxer, Children of Horizons, 1996
Age of Coming Out - 2009
• Girls awareness of same sex attraction: age 11 ½ to 12 • Girls coming out to self: age 14 ½ to 15 • Girls coming out to family: just over age 16 • Boys awareness of same sex attraction: age 9 ½ • Boys coming out to self: age 14 • Boys coming out to family: age15 ½ to 16
C. Ryan study in Pediatrics, 2009
Risk Factors – Sexual Abuse
Risk factors for violence among stigmatized populations? • Sexual & physical abuse – most powerful predictors of high risk behavior • Among girls, 1 in 4 lesbian and bisexual girls report sexual abuse (Prevalence of sexual abuse in hetero
girls ranges from 10-25%)
• Among boys, 1 in 4 bisexual boys & 1 in 5 gay boys reported sexual abuse (Prevalence of sexual abuse
in hetero boys is well under 10%)
Physical Abuse by Family Members
• Girls in all orientation groups report higher prevalence of physical abuse than male peers • Bisexual & lesbian girls report a higher prevalence of physical abuse then hetero girls
(Prevalence among hetero girls is 1 in 4 or 5)
• Gay & bisexual boys also report a higher prevalence of physical abuse, nearly 1 in 5 or 1 in 3 reporting abuse (Prevalence among hetero boys is 1
in 8)
Risk Factors – Violence
• LGB youth are at higher risk for violence in their homes • Gender atypicality, even if not disclosed, creates risk for victimization. • Bisexual youth – higher risk for victimization than lesbian or gay • Higher level of stigma and violence toward LGB youth higher risk-taking behaviors
Risk Factors for Suicide in Queer Youth
• • • • • • • Having a mental disorder Lack of social support Sense of isolation Stigma assoc. w/ seeking help Loss of relationship Access to lethal means Physical/verbal abuse by parents
Suicidal Trans Youth
• Very little research • 45% had SI & ½ of these say it was related to their transgender status • Youth who had made suicidal attempts reprted increased rates of physical and verbal abuse by parents. • Grossman & D’Angelli, 2007
Impact of Families on GLB Youth
• Looked at 9 negative health indicators including mental health, substance abuse & sexual risk • Sample – 245 LGB Latino and non-Latino White young adults ages 21 to 25 years • Criteria – open about SO to at least 1 parent or primary caregiver during adolescence • LGB young adults who reported high levels of family rejection during adolescence were: -8.4x more likely to report suicide attempt -5.9x more likely to report high levels of depression -3.4x more likely to use illegal drugs -3.4x more likely to engage in unprotected sexual intercourse …compared with peers from families that reported no or low levels of family rejection.
C. Ryan Study in Pediatrics, 2009
Gender Variance in Schools
• 26.1% of students have experienced physical harrassment at school due to their gender expression/variance • 11.8% have been physically assaulted • LGBT students are 5 times more likely to have skipped school in the last month due to safety concerns • The avg. GPA for gender variant students feeling physically harrassed was ½ grade lower (2.6 vs. 3.1) than students experiencing less harrassment
GLSEN 2005 survey 1732 students, ages 13-20yrs from 50 states from Trans Youth Family Allies
Gender Variance in Schools – cont’d
• LGBT students were 2x more likely as the general population of students to report they are NOT planning post-secondary education • States with inclusive anti-bullying laws and policies that have specific categories for sexual identity and gender identity have significantly lower rates of verbal harrassment (31.6% vs. 40.8%)
GLSEN 2005 survey 1732 students, ages 13-20yrs from 50 states from Trans Youth Family Allies
Families - What to do?
What do families need to move from rejection to ambivalence to acceptance? How can clinicians/counselors support this process? • Identification of those at risk – most critical element • Education – Advise parents that negative reactions to their adolescents may adversely affect their child’s physical and mental health • Encouragement & resources to decrease rejection
How Can Families Nurture Queerness?
• Encourage all family members to express negative feelings – worries lose steam when voiced • Develop new appreciation for queer youth • Embrace the gifts their child has to offer with their queerness (StoneFish & Harvey, 2005)
Four Competencies to dealing with GLB and GV Youth
• Individualizing – identifying and responding to each youth as an individual, separate from their sexual identity • Strength finding – Highlight strengths in youth to balance the negative elements in their life • Affirming – Affirm youths internal experiences and struggles as important. • Normalizing – Youths need to understand that their feelings and concerns are normal/typical, even when their feelings are inconsistent with the views of others.
Child Welfare League
Queer Affirmative Therapy
• Understanding and Combating Heterosexism & Heterosexual Privelege • Understanding and Moving Beyond Gender Binary Model • Learning to Affirm vs. Alienate
Therapeutic Considerations
• Not disclosing your sexual orientation when asked • Denying your own homo/trans phobia & heterosexism • Not offering resources for clients • ―Sexual preference‖ ―Alternative lifestyle‖ • Heterosexist paperwork/intake ???? • Tabla rasa as therapeutic style • No queer literature in waiting room (Kort, 2008)
Therapeutic Recommendations
• We need to be non-judgmental • We do not have all the answers so don’t pretend like we do. • Keep our Gaydar and Transdar in check • Accept client as total person; sexuality and gender part but not whole person • Hear their voice
Schools
In most cases where LGB & GV youth reported that their school experience has been positive, they attributed that fact to the presence of supportive teachers.
• Confidentiality – Establish and implement policies providing confidentiality in discussions between counselors and students. • Develop and implement policies that prohibit discrimination, harrasment, and abuse of students based on actual or perceived SO or GV. • Ensure that all existing and model complaint mechanisms at the school and district level include provisions for trans/gender variant youth. • Allow GV youth to define themselves in the manner most appropriate for them.
Schools – cont’d
• Integrate age appropriate discussion about gay issues into relevant core curriculum subject areas such as literature, history and current affairs • Include information specific to the needs of LGB & GV youth in health education on sexuality and sexually transmitted diseased. Such info should NOT be presented that being LGB or GV is itself a health problem.
Interventions
• Me & You • Responsive and responsible adults • School – counselor as first responders, supportive administration, curriculum issues • DCF workers – worker turnover and multiple placements inhibit development of a stable and supportive environment for LGB youth • Community education – critical component • Pediatric providers – Ask LGB adolescents about family reactions to SO & GV and refer to community support programs
The Gifts of Queerness
• We have a different way of looking at the world to offer our families • We have provided opportunity for closeness due to sharing our intimate selves • We have recruited our parents to be appropriately involved w/ us in a developmental trajector toward independence (StoneFish & Harvey, 2005)
• • • • •
Check your heterosexist/homophobic countertransference Do I question the origins of my clients’ gayness? Do I assume that same-sex attractions have a pathological origin? Do I allign w/ my client’s reluctance to admit being LGBT? How do I feel about LGBT people having children? Do I think LGBT should not tell others they are LGBT unless they are asked?
Protective Factors for Suicidal Queer Youth
• Access to effective,sensitive,affirming MH/SA treatment (PRIDE Institute) • Restricted access to lethal means • Community supports • Increased coping skills • Strong family connections • Spiritual connectedness
Community Efforts
• • • • • • Houses Your Turf/Rainbow Room True Colors mentoring; foster parents, etc. GLSEN PFLAG GSAs
The Houses
• • • • • • • • Freedom Nations Everlasting Empire Pleasure Q Trailer Park Trash Sappho Bushfire
Queer Cultural Competency & Needed Supports
• Attending TC each year • Rebekah Jackson’s dissertation ―Increasing Competency: A Sexuality and Gender Diversity Training Program for Mental Health Professionals‖ (2008), University of Hartford • GSAs in LMHAs & Substance Abuse facilities of DMHAS • DCF, Corrections, DMR supports for Queer Youth • Queer Youth Shelter(s)
Resources
• Hatred in the Hallways: Violence & Discrimination Against Lesbian, Gay, Bisexual, and Transgender Students in U.S. Schools Human Rights Watch • Child Welfare League of America, 2006 series of articles on GLBT youth from a public health, youth in out-ofhome care, homeless youth & retrospective review of literature. • ―…Mom, I need to be a girl.‖ 2007 By Just Evelyn • TransYouth Family Allies, Inc. (TYFA) www.imatyfa.org • ―Our Trans Children.‖ A publication of the PFLAG Transgender Network.
Other Resources
• CT Clearinghouse booth/ publication/ website • CPA Task Force on Sexuality and Gender Diversity website • CTAC website w/ State-wide Queer Affirming Therapists • Rainbow Heights Club GLBT MI psycho-social www.rainbowheights.org * Trevor Project www.thetrevorproject.org 866-4-U-TREVOR
Sexual Orientation - Sammy
• 15 y.o. male admitted to inpatient unit for suicide attempt; longstanding depression; family history of depression; superficial cutting behavior; some paranoia • Experiencing harassment in school for being effeminate and gay • Conservative religious family; want him to be normal; trying to be supportive • How to modify his school program to help him succeed? • Additional clinical resources
Gender Variance - Jack
• 9 year old boy; has a 5 y.o. sister • Referred for therapy at age 7 for gender dysphoria • Pediatrician told parents to steer him toward boy toys, boy clothes and activities • Loves dressing up in female clothing—dresses, tutus, wigs, tiara, dolls; begged for a Barbie or Hannah Montanna doll; loves mermaids • Mother wanted to be supportive and looked for advice; father was punitive and pushed son toward sports; creates conflict in the marriage
Final Comments
• ―I think (Harvey Milk) would want me to say to all the gay and lesbian kids out there tonight… that you are beautiful, wonderful creatures of value, and that no matter what anyone tells you, God does love you and that very soon, I promise you, you will have equal rights, federally, across this great nation of ours.‖
Dustin Lance Black, Oscar winner for original screenplay for ―Milk‖ at the Oscars on 2/29/2009