Acknowledging the Impact of Social Forces on Sexual Minority Clients: Introduction to the Special Issue on Clinical Practice with LGBTQ Populations

Over the last two to three decades, advances in clinical practice with lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals have been extensive. Many clinical social workers now incorporate LGBTQ-affirmative approaches into their practice, and a number of social workers have contributed to the literature on clinical practice with sexual minority clients. Despite these advances, we still require specialized knowledge to understand a number of LGBTQ-related mental health issues. The Clinical Social Work Journal’s first special issue on clinical practice with LGBTQ populations emphasizes psychotherapy techniques that acknowledge and also address social forces (e.g., transphobia, homophobia, and heterosexism) that affect the psychosocial functioning of LGBTQ clients. The special issue focuses on LGBTQ populations, such as transgender and bisexual individuals, sexual minority youth, and older adults, and psychotherapy modalities informed by a number of clinical and theoretical approaches. These in-depth articles offer guidance to clinical social workers who need to expand their knowledge of LGBTQ-related mental health issues and also provide those with existing knowledge an opportunity to refine their clinical skills and sharpen their thinking.     

A Study of Clinical Change in Individual Career Counseling

This study examined the clinical significance of career counseling effects. Participants were 111 university students (83% women) who participated in individual career counseling sessions at their university. All participants completed the French version of the Outcome Questionnaire–30.2 (OQ‐30.2; Lambert, Finch, Okiishi, & Burlingame, 2005) immediately before the 1st session (pretest) and at the beginning of the last session (posttest). The OQ‐30.2 assesses 3 client life domains: subjective discomfort, problems in interpersonal relationships, and problems in social role satisfaction. Using Jacobson and Truax’s (1991) statistical approach to assessing clinical change, the authors compared clients’ pretest OQ‐30.2 scores with their posttest scores. Among clients with a “dysfunctional” score (n = 59) at the study’s inception, 34% recovered and 14% improved, whereas 41% of clients with functional scores (n = 52) at the study’s inception improved. The results suggest that individual career counseling can make a difference in the lives of many clients; they also highlight the importance of further outcome research that accounts for possible variability in clients’ responses to career counseling.     

Outness among LGBTQ Social Work Students in North America: The Contribution of Environmental Supports and Perceptions of Comfort

This study examines various environmental factors that may impact a lesbian, gay, bisexual, transgender, or queer (LGBTQ) social work student's level of ‘outness’ (disclosure) with regard to their sexual orientation or gender identity. An internet-based survey was conducted, comprised of LGBTQ undergraduate and graduate students from social work programs across North America (n = 1,018). Utilizing Pearson's chi square analysis, significant associations correlated between outness and the following six areas: (1) LGBTQ student perception of other students' overall level of comfort with their sexual orientation or gender identity within the program; (2) the number of faculty that know about their sexual orientation or gender identity; (3) the number of students that know about their sexual orientation or gender identity; (4) how supported they felt with regard to their LGBTQ identity within the program; (5) the percent of faculty that are supportive of LGB and Q issues; and (6) awareness of openly LGBTQ administrators or staff members. Implications for social work education and practice are examined, as are suggestions for continued research.     

Client Psychological Distress: An Important Factor in Career Counseling

The authors explored client psychological distress as a variable in career counseling. Forty‐two clients in a naturalistic setting were seen for a total of 290 sessions by 21 counselors‐in‐training. The results indicated that (a) 60% of the clients were psychologically distressed, (b) clients' scores decreased significantly from pretest to posttest on psychological distress variables, (c) significant linear growth occurred in the clients' perception of the working alliance across sessions, and (d) the psychological distress outcome variables were significantly related to both the first session level of the working alliance and its linear growth.     

Simulated Clients in a Group Practice Course: Engaging Facilitation and Embodying Diversity

Social work students need to develop practice skills with racially and ethnically diverse clients. Previous research has found benefits to using individual simulated clients, and working with a group would not only provide facilitation opportunities, it could also increase students’ exposure to diversity. This article presents a social work group practice class that used simulated clients and the evaluation of the pedagogy using a mixed-methods design. Students’ scores on the Diversity and Oppression Scale significantly improved from pretest to posttest. Focus groups clarified the impact. The results of this exploratory pilot study suggest that this approach allowed students to learn to manage emotional responses, promoted student insights, and provided opportunities to challenge student assumptions.     

Knowledge and Behavioral Impact of Adult Participation in Child Sexual Abuse Prevention: Evaluation of the Protecting God’s Children Program

ABSTRACT

This article presents findings from an evaluation of a popular adult training program (Protecting God’s Children) used in Catholic institutions, including schools, churches, and social service agencies. The study explores knowledge and behavior change based on pretest/posttest questionnaires administered to over 500 adults and follow-up questionnaires sent six months after the training. The participants in the training were compared to a control group of adults who did not participate in the program. The results indicate that participants arrive at the training with fairly high rates of preexisting knowledge but that the program increases knowledge across demographic groups. Follow-up surveys suggest that the new knowledge is retained over six months. The study indicates that the program is associated with an increase in participants talking to their own children about child sexual abuse. Participants also report sharing information with other adults and monitoring behavior around children more closely.     

Health Care Professionals' Experience,Knowledge, and Attitudes Concerning Homosexuality

The purpose of this study was to examine the experience with attitudes towards, and knowledge about homosexuality of three groups of health care professionals. Subjects were 97 registeres nurses, social workers, and psychologists who responded to a six-page mailed questionnaire. Professional discipline of the subject, gender of the client, and gender of the client's lover in a fictitious scenario did not significantly affect ratings or suggested diagnoses of the client. Most subjects felt that they needed moer training in working with homosexual clients, which was consistent with their high but not perfect scores on a knowledge test. Subject's mean scores of the Attitudes Toward Lesbians (ATL) and Gay Men (ATGM) scales of Herek (1998) reflected significantly less prejudice than his college samples. More knowledgeable respondents were less prejudiced and had more positive attitudes about working with gay and lesbian clients; those with more positive attitudes toward clients also showed less prejudice on the ATL and ATGM scales. The authors argue that training health care professionals to be more knowledgeable about gay and lesbian issues would lead to more positive attitudes and better services for gay and lesbian clients.     

Our Story: The Parent and LGBTQ Child Relational Process

This study explores the parent-lesbian, gay, bisexual, transgender, and queer (LGBTQ) child relational process, before and after the child discloses his or her sexual orientation and/or gender identity to his or her parent(s). Eleven parent-adult child dyads were interviewed in this grounded theory study. Participants included children representing the full LGBTQ spectrum and their parents. Results indicate that parent-child dyads experience a relational process occurring in five sequential phases, the last one continuing indefinitely. Parent-LGBTQ child close relationships manifest societal beliefs regarding LGBTQ identities. Dyad members share an evolving relational identity and construct a shared narrative that shifts in response to familial life events and broader societal changes.     

DSM-IV and Social Work Professionals

Abstract

This six-hour group training was designed to gather information in regard to the role of social workers using the Diagnostic and Statistical Manual for Mental Health Disorders (DSM-IV). The intention of the group training was to explore social workers' knowledge and comfort in using the DSM-IV as well as assessing the continuing education experience provided. In total, 132 surveys were circulated during two training groups. All participants were asked to give general information and perceptions of use of the DSM, and were pre and posttested for current levels of understanding and comfort regarding diagnostic usage. Significant relationships were noted between several study variables as well as between pretest and posttest scores. Overall, pre and posttest results yielded a significant positive correlation between comfort levels in utilization of the DSM-IV and formulating a diagnostic impression as a means of identifying certain mental health conditions. Furthermore, the results of this study support that attending this group training increased the comfort and knowledge level of social workers in regard to DSM-IV and 98% of the participants felt that training in this area should be man datory for all social work professionals. Suggestions for future research and education are presented.     

Sex counts: An examination of sexual service advertisements in a UK online directory

Internationally, sex work research, public opinion, policy, laws, and practice are predicated on the assumption that commercial sex is a priori sold by women and bought by men. Scarce attention has been devoted to lesbian, gay, bisexual, transgender, or queer/questioning (LGBTQ) sex working as well as women who pay for sex. This is as much an empirical absence as it is a theoretical one, for the ideological claim that women comprise the “vast majority” of sex workers is rarely, if ever, exposed to empirical scrutiny. Focusing on the UK, we address this major gap in evidence in order to challenge the gendered and heterosexist logics that underpin contemporary debates. We do so by presenting large-scale data gained from the quantitative analysis of 25,511 registered member profiles of an online escort directory. Our findings point to heterogeneity rather than homogeneity in the contemporary sex industry including in terms of gender identity, sexual orientation, and advertised client base. For example, while two-thirds of advertisements self-identify as “Female,” one in four are listed as “Male;” less than half list their sexual orientation as “Straight;” and nearly two-thirds advertise to women clients. Our study thus challenges prevailing heteronormative assumptions about commercial sex, which erase LGBTQ sex workers and other non-normative identities and practices, and which we argue have important political, practical, and theoretical consequences.     

Perceived Competencies of Social Workers in Adolescent Practice

Abstract

This investigation yielded data on the perceived competencies of social workers in adolescent practice. On average, survey respondents related that their perceived knowledge/skill levels ranged from moderate to high when working with depressed, sexually abused youths, or those with behavioral issues. However, respondents also perceived their knowledge/skill levels as moderate to poor when adolescent clients presented with: chronic physical conditions including HIV+/AIDS, sexual orientation issues, gang involvement, or were youths of color. Survey respondents credited work experience and conferences as the primary sources of their perceived practice knowledge/skill. Greater knowledge/skill levels in adolescent practice were associated with greater years of practice.     

Evaluation of the High School Relationship Curriculum Connections: Dating and Emotions

Interest in relationship education for high school students has grown since the Deficit Reduction Act of 2005 provided funding for Healthy Marriage Initiative programs. This study used a pretest and posttest design and measures of relationship knowledge and attitudes to evaluate a relationship curriculum taught in required health education classes to a sample of 139 students. Comparison of students’ pretest and posttest scores showed slight gains in knowledge about relationships. Analysis based on characteristics associated with risk and protective factors for relationship outcomes (gender, academic performance and parental divorce history) found significant differences. Implications for expanding high school relationship education and recommendations for social work involvement in these programs are discussed.     

Cultivating Positive LGBTQA Identities: An Intervention Study with College Students

A brief intervention exercise focusing on positive experiences of lesbian, gay, bisexual, transgender, and queer or questioning young adults and their young adult allies (LGBTQA) was hypothesized to increase positive LGBTQA identity, collective self-esteem, and individual self-esteem. Participants (N = 52) completed pretest, listened to a presentation on positive LGBTQA identities, and wrote personal narratives related to their own positive identity experiences. They then completed posttest and one-month follow-up surveys. Findings indicated that scores on all three outcomes significantly increased between the pre- and posttest but returned to baseline levels when reassessed one month later. Future research should explore ways to enhance the long-term impact of exposure to positive identity interventions on LGBTQA well-being in the current heteronormative cultural environment.     

The Children First Program: The Effectiveness of a Parent Education Program for Divorcing Parents

This study evaluated the effectiveness of the 2nd and 3rd editions of the Children First parent education programs for parents experiencing divorce or separation. Participants were 678 parents experiencing separation or divorce in 2 Midwestern counties. Changes from pretest to posttest on participants’ knowledge, attitudes, and likelihood of adaptive coparenting were assessed. Both editions of the program had a significant positive effect on all 3 measures of adaptive coparenting. The effect sizes from pretest to posttest for the 2nd edition were small, whereas the effect sizes for the 3rd edition of the program were nearly twice as large. Superiority of the 3rd edition might be due to an increased focus on explicit training on adaptive coparenting behaviors.     

Teaching Note—Challenges in the Classroom on LGBTQ Topics and Christianity in Social Work

This article provides guidance in facilitating the development of culturally sensitive skills for working with lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations that take into account power and privilege. Social work faculty and students have an ethical obligation to be competent and aware of privilege. When working with LGBTQ populations, this means addressing personal and social values and beliefs about gender and sexuality. Faculty may not feel prepared to address the influence of Christianity, the dominant religion in the United States, on social forces affecting LGBTQ populations and on social workers’ religious feelings when working with these individuals. This article describes pedagogical techniques and provides guidance for developing faculty and student competence and awareness when working with LGBTQ populations.     

Reconceptualising and contextualising sexual rights in the MENA region: beyond LGBTQI categories

In recent years, LGBTQI rights have become central to debates around international development, human rights, refugee protection, and diversity. Yet research and experience in the Middle East and North Africa (MENA) reveals significant problems with LGBTQI as a way of identifying individuals who do not conform to heterosexual and binary gender norms, in order to support their rights. In this article, we draw on experience of working to advance gender and sexual rights to illustrate the shortcomings of LGBTQI identity categories, and use findings from the Centre for Transnational Development and Collaboration’s (CTDC) four-year programme of research into LGBTQI rights in the MENA region to support our argument further. This research identified major problems in policies and debates on the rights of individuals whose sexual orientation and/or gender identity differs from the norm. In response to this, CTDC has developed a tool to address rights in programme development and advocacy, using a new approach, Sexual Practice and Gender Performance (SPGP), for work in the MENA region.     

Exploring Nonbinary Gender Identities: A Qualitative Content Analysis

This study presents a qualitative exploration of nonbinary gender identities from a counseling framework. We studied 14 participants in an open-ended, online format, all of whom self-identified with nonbinary gender identities. Our analysis explored five primary themes: (a) identity development, (b) heterogenous identities, (c) the identity-expression divide, (d) invisibility and stressors, and (e) resilience and support. Participants’ experiences in counseling and practical implications for counselors working with nonbinary clients are also discussed, including cautions against assumption making, increased need for training and education about nonbinary clients, and nonbinary clients’ perceptions of counselor openness.     

“Getting pregnant might make me seem more normal to them”: Attitudes,experiences, and gendered nuances regarding pregnancy and parenting among youths experiencing homelessness

Homelessness among youths exacerbates an array of challenging life experiences, notable examples of which are pregnancy and parenting. Research is lacking on young men’s attitudes and experiences, and also the influences which homeless youths’ gender identities and sexualities may have on their pregnancy and parenting outcomes and trajectories. This study qualitatively explores gender differentials, including youths’ gender identities and sexual orientations, with regard to their attitudes and experiences of pregnancy and parenting while homeless. Qualitative data were obtained from interviews with a diverse sample of 30 female, male, and transgender homeless youths, ages 18 to 21. Findings revealed that topics of pregnancy and parenting represent a wide range of complexities, different standards, and threats for homeless youths. Although pregnancy is often viewed positively within this community, it is received and experienced differently for each gender and sexuality. Results demonstrate that youths’ unimpeded access to and knowledge of all available reproductive and sexual health care services is essential. These services must be designed and delivered for youths of all gender identities and sexual orientations. Interventions and resources on parenting and co-parenting, particularly models that more inclusively engage a greater diversity of young parents’ involvement, are also urgently needed.     

Perspectives of LGBTQ emerging adults on the depiction and impact of LGBTQ media representation

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) young people have been increasingly represented in traditional (offline) media over the past two decades. However, research had not adequately focused on the content of contemporary representations, how such depictions impact LGBTQ young people, or how young people’s experiences are affected by the present context characterized by the rapidly increasing prevalence of new (online) media. Utilizing grounded theory with a sample (n?=?19) of emerging adults (age 18–22), this study investigates: (1) messages about sexual orientation and/or gender identity LGBTQ emerging adults receive from LGBTQ representations in traditional media; (2) potential differences in the experiences of LGBTQ emerging adults with traditional media compared to new media; and (3) how consumption of these media messages impact LGBTQ emerging adults. Results indicate that while traditional media (particularly television) creates a common dialogue and validates identity, it continues to represent LGBTQ people as one-dimensional and stereotypical, ignores many LGBTQ sub-groups, limits LGBTQ young people’s perceptions of their future trajectories, and offers no opportunities for critique. In contrast, emerging new media offers new, important, and valued spaces for discussion and creativity.     

Differentiating the Social Service Needs of Homeless Sexual Minority Youths from those of Non-homeless Sexual Minority Youths

While homeless youths and sexual minority youths are at greater risk for negative life experiences, and homeless sexual minority youths are at greater risk than homeless heterosexual youths, little is known about the differential risks for homeless sexual minority youths compared to non-homeless sexual minority youths. Using a sample of 187 sexual minority youths from a community-based social service agency in Denver, Colorado, the findings of this study suggest that homeless sexual minority youths are at greater risk for victimization, mental health issues, substance abuse, and illegal or dangerous activities than their non-homeless counterparts. Implications for social work practice and social service provision are discussed.