What Everyone Needs to Know When Working With Sexual Minorities

What Everyone Needs to Know When
Working With Sexual Minorities
Presented by:
Joseph M. Amico, M.Div., CAS, LISAC
President of NALGAP:
The Association of Lesbian, Gay, Bisexual,
Transgender Addiction Professionals and Their Allies.
Anne Helene Skinstad, PhD
Project Director
Candace Peters, MA, CADC
Director of Training
The ATTC Network
ATTCnetwork.org
Southern
Coast
Prairielands Addiction Technology Transfer Center
Minnesota, Iowa, North Dakota, South Dakota and Wisconsin
For more information contact: [email protected]
Tele: 319.335.5368
Every day, countless lives are enriched or
saved because of the work carried out by
behavioral health counselors.
In a myriad of settings, competent, welltrained counselors form the relationships
and carry out the strategies that help their
clients move from life-threatening
addiction to life-affirming recovery…
We can state with certainty that thousands
of behavioral health counselors accomplish
their missions with distinction.
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What Everyone Needs to Know When Working
With Sexual Minorities
Joseph M. Amico, M. Div., CAS, LISAC
President
NALGAP
Candace Peters, MA, CADC
Director of Training
Prairielands ATTC
Continuing Education Unit (CEU)
1.5 NAADAC continuing education hours are available
to those attending the LIVE iTraining Webinar today.
Participants will receive an e-mail from Ms. Perumalla
from the ATTC Nation Office following the conclusion
of today’s iTraining with instructions on how to obtain
the CEUs. Please note:
While the training today is FREE, there is a small fee
of $15 for the NAADAC hours. You should receive the
information by COB Friday, 6/17
NAADAC CEU’s are available upon request for this
session at a cost of $15.00.
Participants are responsible for submitting state
specific requests under the guidelines of their
individual state.
Power Points
An Electronic copy
of the webinar
Power Point is
available upon
request.
For more information on CEU’s, power points or registration, please
contact: …
Presented by:
Joseph M. Amico, M.Div., CAS, LISAC
Joe is known for presenting at international conferences and training
professionals on alcohol, drug and sex addiction. Joe recenly organized the first
LGBT inpatient psychiatric and detox unit in New England for the Brattleboro
Retreat. He is the President of NALGAP, the Association for Lesbian, Gay,
Bisexual, Transgender Addiction Professionals and Their Allies; on the editorial
board for Addiction Professional, and published numerous articles on LGBT
Addiction Issues.
Candace Peters, MA, CADC
Candace received her Master of Arts degree in Substance Abuse and Mental
Health Counseling, at the University of Iowa. She has counseled persons
with co-occurring disorder and has supported counselors with clinical
supervision at all levels of care. Candace developed, supervised, managed,
and administered outreach and case management programs, transitional
housing programs for persons and their families in substance abuse recovery
and persons who are homeless. Candace is Director of Training with the
Prairielands Addiction Technology Transfer Center (ATTC).
Curriculum Development
A Provider’s Introduction to Substance Abuse
Treatment for Lesbian, Gay, Bisexual, and
Transgender Individuals
Based on the publication: (DHHS Publication No. (SMA) 01-3498) First Edition
The curriculum was created to “translate” the original 2001 text into a training
experience with visual aids and opportunities for discussion & practice.
Edited and prepared for publication by the Prairielands ATTC by:
Anne Helene Skinstad, PhD, Project Director
Candace Peters, MA, CADC, Director of Training
Jennifer Kardos, MA, Instructional Designer
The original curriculum and training activities were authored by:
Barbara Warren, PsyD, CASAC, CPP, Dir. of Organizational Development,
Planning and Research, The Lesbian, Gay, Bisexual, and Transgender
Community Center of New York City
Trainers
•
Released in September 2007, NALGAP conference in Nashville, TN
Training of Trainers :
128 trainers have participated in seven Training of Trainers throughout the
United States and Puerto Rico
Master Trainer:
Thomas E. Freese, Ph.D., Director, Pacific Southwest Addiction Technology Transfer
Center, and Director of Training, UCLA Integrated Substance Abuse Programs
Joe Amico, Ed Johnson, Daniel Toleran and Joanne Keatley
Trainer Expectations:
Pre-training Expectations: Participants will be asked to complete a electronic “pre-training
notebook” prior to the scheduled Training of Trainers event, to include:
Adult Learning
Training Style Inventory (TSI)
Learning Modalities
Journal Articles
Curriculum Training Guide
Original SAMHSA Publication
Post-training Expectation:
Participants will engage in a learning community in collaboration with Prairielands ATTC
and will work with their respective ATTC in delivering the training.
Curriculum Content
The curriculum is intended to provide both practitioners and administrators
involved in substance abuse treatment with:
• Increased familiarity with the issues and barriers faced by LGBT persons
in need of substance use disorder-related services
• Knowledge about the interaction between LGBT issues and substance use
and abuse
• Enhance abilities to offer sensitive, affirmative, culturally relevant, and
effective treatment to LGBT clients in substance use disorder
treatment.
This curriculum was designed to be offered by experienced substance
abuse treatment trainers.
This training confronts what are often controversial issues in our society
about sexual orientation and gender identity, and trainers need to have
experience facilitating discussion and response, handling dissent, and
mediating differing opinions and attitudes.
Curriculum Modules
Overview of Treatment Approaches, Modalities, and Issues of
Accessibility:
Module
Module
Module
Module
One:
Two:
Three:
Four:
An Overview for Providers Treating LGBT Clients
Cultural Issues in Working with LGBT Individuals
Legal Issues for Programs Treating LGBT Clients
Overview of Treatment Approaches, Modalities, and Issues of Accessibility in the Continuum of Care
Clinician’s Guide
Module
Module
Module
Module
Module
Module
Module
Module
Module
Five:
The Coming out Process for Lesbians and Gay Men
Six:
Families of Origin and Families of Choice
Seven:
Clinical Issues with Lesbians
Eight:
Clinical Issues with Gay Male Clients
Nine:
Clinical Issues with Bisexuals
Ten:
Clinical Issues with Transgender Individuals
Eleven: Clinical Issues with Youth
Twelve: Related Health Issues
Thirteen: Case Examples: Counselor competence in Treating LGBT Clients
Program Administrator’s Guide
Module
Module
Module
Module
Fourteen: Policies and Procedures
Fifteen:
Training and Education
Sixteen:
Quality Improvement and LGBT Clients
Seventeen: Using Alliances and Networks to Improve Treatment for LGBT Clients
For more Information
Prairielands ATTC
http://www.attcnetwork.org/regcenters/index_prairielands.asp
tele: 319.335.5368
Anne Helene Skinstad, PhD, [email protected]
Candace Peters, MA, CADC, [email protected]
or
contact your regional ATTC at www.attcnetwork.org
This training is supported by the Substance Abuse and Mental
Health Services Administration, Center for Substance Abuse
Treatment.
Technical guidance and program direction for this curriculum was provided
by the Substance Abuse and Mental Health Services Administration,
Center for Substance Abuse Treatment, were provided by:
Edwin Craft, DrPh, MED, LCPC
Catherine D. Nugent, LCPC
Workshop Alphabet Soup
GLBTQQAi2S
Politically Correct Terms
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Gender Variant
Gender Queer
Gender Neutral
Gender Expression
Gender Identity
Transphobia
DSD (Disordered Sexual Development)
Sexual Identity
4 Components
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Physical Identity: Biological sex
Gender Identity: Psychological sense of being male
or female
Sex-Role Identity: Interests, attitudes, appearance,
and behaviors-masculine, feminine, androgynous
Sexual Orientation: Gender/sex attracted to
sexually and romantically
-Heterosexual
-Bisexual
-Gay
-Lesbian
THE “GAY RIGHTS” MOVEMENT
IS BORN
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STONEWALL RIOTS
JUNE 27, 1969
STONEWALL INN, CHRISTOPHER ST.
GREENWICH VILLAGE, NYC
FIRST ANNIVERSARY INITIATED
ANNUAL GAY PRIDE EVENTS
Kinsey Continuum
Heterosexual
Homosexual
0-----1-----2-----3-----4-----5-----6
2%
2%
Klein Grid
For variables A to E:
1 = Other sex only
2 = Other sex mostly
3 = Other sex somewhat more
4 = Both sexes
5 = Same sex somewhat more
6 = Same sex mostly
7 = Same sex only
For variables F and G:
1 = Heterosexual only
2 = Heterosexual mostly
3 = Heterosexual somewhat more
4 = Hetero/Gay-Lesbian equally
5 = Gay/Lesbian somewhat more
6 = Gay/Lesbian mostly
7 = Gay/Lesbian only
Fundamentals
for working with
gay/ lesbian/ bisexual/ transgender/ queer/
questioning/ and intersex clients
1)Examine your own beliefs and feelings
about sexual orientation.
2) If you are comfortable with diverse sexual
orientations on your caseload, here are
suggestions for making the client more
comfortable and letting the client know that
it is “ok” to be GLBTQQi in this office:
a. Provide GLBTQQi literature or artwork in the waiting area.
b. On your intake forms, be sure that same sex relationships
can be easily reported.
c. Know the developmental stages of coming out.
PSYCHOSOCIAL QUESTIONS
1. How old were you when you had your first
thoughts about being gay (or lesbian,
bisexual, transgender)?
2. How old were you when you first acted on
those thoughts?
3. Describe for me your first sexual
experiences (may or may not be the same
as number 2).
4. When was your first sexual experience with
an adult?
5.
Who are you "out" to? (Be sure to ask about
friends, family or work)
6.
How to you feel about being gay?
7.
If you could change your sexual orientation,
would you?
SEXUAL IDENTITY FORMATION:
A THEORETICAL MODEL
Based on the work of Vivienne C. Cass
STAGE I:
Identity Confusion:
Occurs when there is continuing personalization of
information regarding sexual identity. Individuals may
react to confusion (coping mechanisms) by utilizing
one of the following:
1. Inhibition strategy
2. Personal innocence strategy
3. Information seeking strategy
STAGE II: Identity Comparison:
Occurs when the person accepts the possibility that she/he
might be gay/lesbian/bisexual/transgender.
Individuals usually utilize one of the following
approaches:
1. The person reacts positively to being different and
devalues the importance of heterosexuals in her/his life.
2. The person accepts the definition of own behavior
as g/l/b/t but rejects a definition of self as g/l/b/t in
her/his own life.
3. The person accepts self and behavior as g/l/b/t but
so fears negative reactions from others that overt g/l/b/t
behavior is inhibited, g/l/b/t is devalued, heterosexuality
is given much positive weight.
STAGE III: Identity Tolerance:
Occurs when the person has come to accept
the probability that he/she is g/l/b/t and
recognizes the sexual/social/emotional
needs that go with being g/l/b/t.
STAGE IV: Identity Acceptance:
Occurs when the person accepts rather
than tolerates a g/l/b/t self-image and
there is continuing and increased
contact with the g/l/b/t culture.
STAGE V: Identity Pride:
Occurs when, accepting the
philosophy of full legitimization,
the person becomes immersed in the
l/g/b/t subculture and has less and
less to do with heterosexual others.
STAGE VI: Identity Synthesis:
Occurs when the person develops an
awareness that the "them" and “us”
philosophy, in which all heterosexuals
are viewed negatively and all g/l/b/t
positively, no longer holds true.
SUB CULTURES AND
STEREOTYPING
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ALL GAY MEN ARE EFFEMINATE
ALL LESBIANS ARE BUTCH
BISEXUALS ARE JUST GAYS WHO HAVEN’T COME OUT
LEATHER
BEARS
S & M/BDSM
CIRCUIT PARTIES
DADDY/BOY
CHUBS/CHASERS
LIPSTICK LESBIANS
LESBIAN BED DEATH
ETHNIC CULTURES
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Men on the “Down Low”
Homosexuality is a “white man’s disease”
Machismo = Latinos can only be “tops”
Two Spirits
Third and Fourth Gender
Blue Collar Lesbians vs. Feminist Lesbians
THE EFFECTS OF SEXUAL/PHYSICAL VICTIMIZATION AND
CULTURAL VICTIMIZATION (HETEROSEXISM)
EFFECTS OF SEXUAL/PHYSICAL
VICTIMIZATION
EFFECTS OF HETEROSEXISM
Blame Self for Causing
the Abuse
Blame Self Because of
One’s Sexuality
“I deserved to be abused”
“Maybe g/l/b/t people are sick and I deserve to be put
down and beat up.”
“It’s my fault”
“Maybe I can stop being g/l/b/t and become
heterosexual….I’ll get married…have children.”
“I should have stopped the abuse”
Shame/Negative SelfConcept
Shame/Negative SelfConcept
“I’m dirty for participating in the sexual acts”
“I’m going to hell for being g/l/b/t”
“I’m bad, otherwise I wouldn’t have been hit.”
“I’m bad for acting on my g/l/b/t desires”
“No one will love me because I’m damaged/used.”
“No one will love me because I’m g/l/b/t…especially
my friends and family”
THE EFFECTS OF SEXUAL/PHYSICAL VICTIMIZATION
AND
CULTURAL VICTIMIZATION (HETEROSEXISM)
•EFFECTS OF SEXUAL/PHYSICAL
VICTIMIZATION
Anger Directed at Self
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“I’m going to kill myself”
“I’ll drink/drug so I can forget what
happened”
“I’m going to go do to someone
else what happened to me”
Victim Mentality
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“I feel helpless/powerless”
“Other people are in control of my
body”
“I can’t tell anyone what happened”
“I don’t trust anyone”
“I’m going to protect myself by
staying alone.”
•EFFECTS OF HETEROSEXISM
Anger Directed at Self
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“I’m going to kill myself”
“I’ll drink/drug to forget about
being sexual with someone of the
same sex”
“I’ll drink/drug so I can get the
courage to be sexual with someone
of the same sex.”
Victim Mentality
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“I feel helpless/powerless”
“I can’t come out”
“I can’t be what I am”
“There is no one I can tell I’m
g/l/b/t”
“I’m not going to tell the neighbors
I have a lover. I’ll just say s/he is
my friend/room-mate.”
THE HEALING PROCESS FROM SEXUAL/PHYSICAL VICTIMIZATION AND
CULTURAL VICTIMIZATION (HETEROSEXISM)
RECOVERY FROM
SEXUAL/PHYSICAL ABUSE
RECOVERY FROM
HETEROSEXISM
Breaking the Silence
Breaking the Silence
“I have been abused”
“Mom, I’m gay (lesbian, bi, transgender)”
“Pastor, I’ve really struggled with my sexual
feelings and I think I’m (g/l/b/t)”
Establish Perpetrator
Responsibility
Establish Perpetrator
Responsibility
“I didn’t ask to be sexually abused”
“I didn’t do anything to be harassed”
“I didn’t deserve to be abused”
“I don’t deserve to be shamed for being who I am”
“(Name) abused me”
“(Name individuals/institution) have shamed and
abused me because of my sexual orientation”
THE HEALING PROCESS FROM SEXUAL/PHYSICAL VICTIMIZATION AND
CULTURAL VICTIMIZATION (HETEROSEXISM)
Reclaim Personal Power
Reclaim Personal Power
“I am okay”
“I am okay”
“I am loveable”
“I am loveable”
“I deserve respect”
“I deserve respect”
“I demand respect”
“I demand respect”
“I set my own boundaries regarding my sexual
behavior/physical space.”
“I decide who I come out to and how much
about my personal life I will share”
“My God loves and accepts me for who I am”
“My gayness is a gift from God”
“My gayness is a gift from my parents”
Adapted from J. H. Neisen (1993) Healing from cultural victimization: Recovery from shame due to heterosexism. Journal of Gay and Lesbian
Psychotherapy, Vol 2 (1), pp 49-63
CONTINUUM OF GAY/LESBIAN/BISEXUAL/TRANSGENDER
SENSITIVE AND SPECIFIC TREATMENT PROGRAMS
Adapted from J. H. Neisen, 1995
Anti Gay Treatment Providers
Traditional Treatment Providers
No G/L/B/T sensitivity
No G/L/B/T sensitivity
Antagonistic toward G/L/B/Ts
Don’t realize they have G/L/B/T clients
Treatment program focus is exclusively for
heterosexuals and deliberately excludes or tries
to change g/l/b/t’s
No acknowledgement or discussion of g/l/b/t
clients/issues
Everyone is assumed to be heterosexual
No specific g/l/b/t treatment components
No specific g/l/b/t treatment components
CONTINUUM OF GAY/LESBIAN/BISEXUAL/TRANSGENDER
SENSITIVE AND SPECIFIC TREATMENT PROGRAMS
Adapted from J. H. Neisen, 1995
Gay Naïve Treatment Providers
Gay Tolerant Treatment Providers
No G/L/B/T sensitivity
Minimal G/L/B/T Sensitivity
Realize they have had G/L/B/T clients
Currently recognize they have g/l/b/t clients
As an agency, have not yet begun to address
the special issues g/l/b/t clients face
No specific g/l/b/t treatment
components
Some staff may verbalize to clients that it’s
okay to be g/l/b/t; however discussions about
being g/l/b/t usually happen in individual
sessions as concerns remain as to “how the
group would handle a g/l/b/t person.” No
defined plan or policy as to how the staff
would deal with homophobic and heterosexist
comments/actions
No specific g/l/b/t treatment
components
CONTINUUM OF GAY/LESBIAN/BISEXUAL/TRANSGENDER SENSITIVE AND
SPECIFIC TREATMENT PROGRAMS
Adapted from J. H. Neisen, 1995
Gay Sensitive Treatment
Providers
Gay Affirming Treatment
Providers
Moderate Level Sensitivity
Highest Level Sensitivity
Several clients and/or staff are open about their
sexual orientation
All treatment workshops and groups are
designed specifically for g/l/b/t individuals.
May have several workshops and/or groups
focusing on g/l/b/t issues
May have some groups specifically for g/l/b/t
clients
Therapy groups and workshops are never
mixed with heterosexual groups
All workshops move beyond g/l/b/t sensitivity,
but affirm the g/l/b/t individual
Workshops on addiction issues incorporate
special issues facing g/l/b/t individuals
May have a “track” program that does G/L/B/T
specific groups but also has G/L/B/T clients mixed
with general population in other groups
Special workshops on g/l/b/t issues always tie
back to sobriety issues
Treatment program has g/l/b/t magazines/newspapers
available. Posters and other images of the g/l/b/t
communities are displayed throughout facility
Some g/l/b/t specific treatment components
All treatment components g/l/b/t specific
WORDS, WORDS, WORDS
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Fags
Queers
Sissies
Tomboys
Queens
Princess
Drag Queen
Drag King
Beards
Skirts
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Bare Backers
Bug Chasers
Twinks
Party and Play (PNP)
Tops and Bottoms
Fuck Buddy
Jocks
Straight Acting
Breeders
Pig
Cut/Uncut
MORE WORDS, WORDS, WORDS
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Dyke
Bull dyke
Baby dyke
Butch
Stone butch
Lezzie, lezbo
Lebanese
Fem
Fluff
Bluff
Political lesbian
Separatist
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Womyn
Herstory
Bi
AC/DC
Tranny, trannie
Pre-op
Post-op
FTM
MTF
Friend of Dorothy
“you-know”
Fag Hag
CONTACT INFORMATION
JOE AMICO
Telephone: 603-852-3168
Email: [email protected]
Website: www.joeamico.com
CANDACE PETERS
Telephone: 319.335.5362
Email: [email protected]
Website:
http://attcnetwork.org/regcenters/index_prairielands.asp
Questions and Discussion
Thank You!
Your feedback is very important to us! At this time, you will be
directed to a short survey about today’s ATTC Network iTraining.
Please join us again next month!
Thursday, July 21, 2011
Serving the Elderly
Hosted by: Mid-Atlantic ATTC
Thank you for your dedication in
serving those who battle
behavioral health issues.
Joe Amico and Candace Peters
Anne Helene Skinstad, PhD
Project Director