Psychotherapy with Lesbian,Gay, Bisexual,and Transgender Older Adults

A small literature has addressed psychotherapy with lesbian, gay, bisexual, and transgender (LGBT) samples over the past two decades. Older adults have also been investigated in a growing number of psychotherapy research studies. However, psychotherapy specifically with LGBT older adults has not received adequate investigation. This review relies on converging lines of research to provide an integrated discussion of evidence-based psychological treatments (EBTs) with current research and clinical observations in the field of gerontology and suggests ways in which these topics can inform psychotherapy practice with LGBT older adults. We summarize current research on aging in several areas of practical interest to psychotherapists seeking to apply EBTs in their work with LGBT older adults. These areas include: adult development, coping, stigmatization, social context, and the effects of cohort membership. The results of these studies belie stereotypes regarding both the aging process, in general, and more specifically LGBT older adulthood, with significant implications for the practice of psychotherapy. EBTs are adaptable to a variety of issues encountered in later life by LGBT older adults, and these modifications to therapeutic technique are addressed throughout.     

“What About the Rest of Us?” An Overview of LGBT Poverty Issues and a Call to Action

In this article, I argue that, despite the myth of gay affluence, existing research is conclusive enough to claim that lesbian, gay, bisexual, and transgender (LGBT) adults are overall less financially secure than their heterosexual, cisgendered counterparts. I demonstrate that LGBT poverty is a broad social issue that can no longer be viewed as affecting only specific subpopulations of LGBT communities. I argue that the social work profession and the LGBT movement need to recognize LGBT poverty as a social issue. I then present a call to action for social work practitioners, researchers and LGBT organizations.     

Lesbian and gay men’s perceptions of their local area agency on aging

This article reviews data from a qualitative study of lesbians and gay men about engagement with their local Area Agency on Aging (AAA). Findings include lack of knowledge about the local AAA, feelings of exclusion, and the need for better outreach. It is important that AAAs engage their local lesbian, gay, bisexual, and transgender (LGBT) elders, as data show they are at higher risk for aging alone and can often harbor mistrust of formal services due to lifetimes of discrimination. Suggestions on where AAAs can find training and resources on reaching out to the LGBT older adult community and implications for the profession of social work are provided.     

Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Dance of the Dedicated Bottom

Abstract

LGBT caregiving for midlife and older adults facing chronic illness or disability as well as the development and evaluation of interventions targeting LGBT caregivers remains fundamentally unexplored. Caregivers regardless of their sexual orientation or gender identity often juggle multiple roles and responsibilities leading to increased stress and distress. However, largely due to discrimination and discriminatory policies, many LGBT caregivers face barriers at multiple levels of service provision that can exacerbate stress and negatively impact caregiver and care recipient quality of life. This article highlights many of these obstacles and provides examples of intervention strategies designed to assist LGBT caregivers ranging from interventions aimed at the individual and interpersonal levels of service provision to changes needed at the social policy level. As an example of an individual or interpersonal level of intervention designed to assist LGBT caregivers, the SURE 2 framework is presented and more thoroughly discussed. Given the diversity of the LGBT community, the article ends with ways to extend or adapt SURE 2 as well as suggesting that the time has come to develop and test a variety of interventions for LGBT caregivers.     

It Takes a Community: Older Lesbians Meeting Social and Care Needs

Although specialized formal services are becoming more prevalent in addressing the needs of the older LGBT community, little is known about informal groups that have organized to meet the needs of this population. This article presents two case examples that depict the efforts of older lesbians to meet the social and care needs of members of their communities. The concept of psychological contracting is used to analyze these experiences, and combined with a review of the literature, practice implications for care and support for this special population are discussed.     

Yet another minority issue or good news for all? Approaching LGBT issues in European social work education

ABSTRACT

This article addresses the questions of why to include and how to approach LGBT issues in the context of European social work education. Referring to social work’s commitment to LGBT people, the article points out its ongoing relevance as questions of marginalisation and discrimination point far beyond formal equality in legislation and normalisation of homosexuality within existing societal institutions. Furthermore, new questions and dynamics in rapidly changing and highly diverse societal contexts bring about new challenges in addressing LGBT issues. Against this background, the article discusses problems of representation and knowledge and underlines the potential of a queer approach. A queer perspective questions taken-for-granted assumptions about sexual orientation, gender identity and intimate relationships. It challenges normalising categories of sex, gender and desire and brings out possibilities existing beyond the heteronormative order. This way, it offers social work education a powerful theoretical lens to address issues on sexual orientation and gender identity not only as yet another minority issue, but as transversal matter and as good news for all. In this article, we use the acronym LGBT to refer to lesbian, gay, bisexual and trans people. LGBT is meant to include and at the same time emphasise the differences between people who do not (exclusively) define themselves as heterosexual and who cannot or do not want to match or identify with binarities of sex, gender and desire. We do not use the acronym LGBTI because we find it problematic to include intersex people without taking explicitly into account their specific situations and needs. Making a plea for a queer approach, we share – of course – a critical view on categorisations and identity labels.     

The spiral of advocacy: How state-based LGBT advocacy organizations use ground-up public communication strategies in their campaigns for the “Equality Agenda”

This article outlines the communication and outreach strategies used by state-based LGBT advocacy organizations. Leaders of these organizations explained through in-depth interviews that their campaigns address four policy areas: non-discrimination, hate crimes, safe schools, and relationship recognition. LGBT citizens and allies serve as spokespersons. They convey stories of the LGBT experience and reinforce LGBT issues as mainstream concerns. State-level advocacy emphasizes that substantive change occurs from the ground up; change nationally requires a critical mass of support first at local levels. This article demonstrates how public relations can serve as a tool for democracy and an instrument of social change, and how “managing legitimacy” can be placed as central to the public relations’ process.     

Specifying Long-Term Care Provider Responsiveness to LGBT Older Adults

In-depth interviews and focus groups with lesbian, gay, and transgender older adults addressed the question “What does it mean for long-term care providers to be responsive to lesbian, gay, bisexual, and transgender (LGBT) older adults?” Sixteen domains of long-term care provider responsiveness to LGBT older adults were identified, including awareness of centrality of partners, knowledge of importance of preferred gender expression, openness to welcoming LGBT older adults, and ability to create LGBT-safe environments. Future research should include LGBT elders who belong to ethnic minority groups, bisexual elders, and LGBT older adults who do not identify with LGBT labels.     

Abuse and older lesbian,gay bisexual,and trans (LGBT) people: a commentary and research agenda

With increasing visibility of older lesbian, gay, bisexual and trans (LGBT) people, there is an urgent need to understand abuse in their lives. This is an under-researched area, which this scoping study (based on a literature review and a small subset of data taken from a larger project) serves to demonstrate. The content of this article formed the basis of a paper presented at a workshop on ‘LGBT Elder Abuse’ held at Keele University(UK) in 2017, convened and chaired by the author. It considers LGBT elder abuse in terms of polyvictimisation, intersectionality and the abuse of power. The identifies knowledge gaps, proposes a research agenda, and explains why such an agenda matters. In particular, the need for researchers of elder abuse, LGBT domestic abuse and organisational abuse to cut across their traditional boundaries of inquiry in order to address how the abuse of older LGBT people intersects with each domain     

“I'm still raring to go”: Successful aging among lesbian,gay, bisexual,and transgender older adults

While we know that minority status differentiates the experience of aging, little research has been done to examine the ways in which patterns of successful aging may differ in diverse subgroups of older adults. In this exploratory study, we investigated and described experiences of successful aging in a sample of lesbian, gay, bisexual and transgender (LGBT) older adults. Directed by a community-based participatory research process, we conducted semi-structured in-depth interviews with 22 LGBT adults, age 60 and older. We took an inductive, grounded theory approach to analyze the taped and transcribed interviews. We coded respondent experiences in four domains: physical health, mental health, emotional state and social engagement. Four gradations of successful aging emerged. Very few in our sample met the bar for “traditional success” characterized by the absence of problems in all four domains of health. Most of the sample was coping to a degree with problems and was categorized in one of two gradations on a continuum of successful aging: “surviving and thriving” and “working at it.” A small number was “ailing”: not coping well with problems. Some of the experiences that respondents described were related to LGBT status; others were related to more general processes of aging. The research suggests that a successful aging framework that is modified to include coping can better describe the experiences of LGBT older adults. The modified conceptual model outlined here may be useful in future research on this population, as well as more broadly for diverse populations of adults, and may be adapted for use in practice to assess and improve health and well-being.     

Preparing social workers for practice with LGBT populations affected by substance use: perceptions from students,alumni, and service providers

Trends in the field of service among those with alcohol and other drug addictions highlight the urgent need for schools of social work to effectively train students to serve clients with substance use disorders, and have cultural humility to effectively serve disproportionately affected LGBT consumers. Online surveys and interviews examined perceptions of graduate social work students and alumni in a certified alcohol and drug counselor program, along with several service providers within an urban setting in the US. Results indicated that students and alumni did not feel adequately prepared through coursework to practice with LGBT populations affected by substance use, while feeling more clinically competent to practice with LGB individuals, than with transgender consumers. Similar findings related to unique differences associated with perceptions of faculty support, along with field preparedness to practice with LGB individuals when compared to transgender individuals. Service providers noted an overall commitment and to serve LGBT consumers as well as positive perceptions of students and alumni to do the same. Implications examine the role of faculty in addressing challenges related to preparation of social work students to practice with LGBT consumers affected by substance use disorders, along with suggestions for curricular changes, and ongoing field trainings.     

LGBT Faculty,Research, and Researchers: Risks and Rewards

ABSTRACT

Self-identified lesbian, gay, bisexual, and transgender (LGBT) faculty along with heterosexuals with scholarly interests in these populations can face heterosexism, heterocentrism, homophobia, and hostility within and outside of social work programs. This article describes the risks and rewards of being an LGBT faculty based on the experiences of the authors. Myths and realities relating to coming out, promotion, and funding are discussed, along with the pitfalls of tokenism and the stress of being an LGBT faculty of color. Ways to endure and even thrive in spite of these potentially formidable burdens are also described.     

INTERNET RESOURCES

Abstract

The Internet has been an important way for lesbian, gay, bisexual, and transgender (LGBT) people to connect with one another since it was discovered by the community in the late 1980s (Weinrich, 1998). It offers anonymity and easy access, helping those isolated by geography, disability, ignorance, or fear to connect with other individuals and become part of a larger community (Alexander, 1997; Haag & Chang, 1998). With so many LGBT people communicating with each other and gathering information online, it is essential that social service professionals understand how this is done, the climate in which it occurs, and what kind of information people are retrieving. Knowledge of the increasingly sophisticated resources available to professionals online can also help those who work in policy development and social research. This article discusses searching for information on the Internet and reviews several directories, including some specifically oriented for LGBT users.     

Examining Associations Between Discrimination,Social Cohesion,and Health among White LGBT versus POC LGBT Chicagoans

Consistent with the minority stress perspective, lesbian/gay, bisexual, and transgender (LGBT) individuals on average report worse health than heterosexual individuals in several domains, for example, general health, mental health, physical health, and healthcare access. Intersectionality-based research shows that LGBT people of color (POC) are, on average, at even greater risk for adverse health outcomes. Discrimination and social cohesion may be two mechanisms underlying these between- and within-group disparities, given that both constructs are frequently reported within marginalized populations, and that both broadly relate to health. This study used data from the Chicago Department of Public Health to examine broad health differences between White LGBT and LGBT POC, and to test specific models in which social cohesion mediated links between discrimination and health. LGBT POC reported experiencing worse general health, lower access to health care, more experiences of discrimination, and lower feelings of social cohesion than did White LGBT individuals. No mediation effects emerged; however, there was a direct effect of experiencing discrimination on mental health distress. Discrimination exposure inversely related to the feelings of social cohesion.     

Denied Citizens of Turkey: Experiences of Discrimination Among LGBT Individuals in Employment,Housing and Health Care

The purpose of this article is to explore experiences of discrimination against lesbian, gay, bisexual and trans (LGBT) individuals in three domains of social policies: employment, housing and health care — domains in which LGBT individuals are not openly recognized as equal citizens and anti‐discrimination legislation is absent in Turkey. Drawing on qualitative content analysis of the data collected from 14 focus group interviews with 139 LGBT individuals conducted in ten provinces of Turkey in the first half of 2014, this article sheds light on diverse forms of discrimination facing LGBT individuals in employment, housing and health care in a largely under‐researched country. The article concludes that the contemporary understanding of Turkish citizenship and its practice are rooted in heterosexist universalism that does not recognize LGBTs as equal citizens, which, in turn, leads to systematic breaches of LGBTs' social rights in employment, housing and health care. The article shows that even strong and universalistic social policies fail to serve LGBTs on an equal footing with other citizens unless equal citizenship rights of LGBTs and anti‐discrimination principles are recognized and realized.     

Social Workers’ Attitudes Toward Older Adults: A Review of the Literature

Ageist attitudes toward older adults have been recognized as barriers to recruiting and training competent social workers. This article provides a systematic review of the literature that focused on social workers’ and social work students’ attitudes toward older adults and working with older adults. The authors sought empirical studies that used an attitudinal measure of ageism with a social work sample, and a total of 20 articles met the criteria. Characteristics of the studies’ participants, methodology, instruments, and results were evaluated. This article discusses the findings and offers implications for future research.     

Characteristics of LGBT caregivers of older adults: Results from the national Caregiving in the U.S. 2015 survey

Using data from the Caregiving in the U.S. 2015 national survey, we compared characteristics of lesbian, gay, bisexual, and transgender (LGBT) and non-LGBT caregivers of older adults and explored predictors of caregiver strain. LGBT caregivers were younger, more racially/ethnically diverse, and less frequently a spouse/partner compared with their heterosexual counterparts. LGBT caregivers more frequently reported helping with medical nursing tasks and reported higher levels of financial strain. While LGBT identity was not an independent predictor of greater strain, characteristics more frequently reported by LGBT caregivers were, for instance, helping with medical nursing tasks. In addition, LGBT individuals who were children of the older adult were more likely to report higher levels of emotional strain than other relationship types.     

LGBT Religious Activism: Predicting State Variations in the Number of Metropolitan Community Churches, 1974–2000

Armstrong and Bernstein (2008) critique the emphasis movement scholars place upon activism within the formal political sphere, proposing, instead, a multi‐institutional approach which argues that protest can occur within any social institution and that the desired outcomes of activism can include cultural outcomes. The goal of this article is to expand the range of social movement targets studied through an examination of lesbian, gay, bisexual, and transgender (LGBT) activism within the institution of religion. In the United States, religion, particularly Christianity, is used as the primary justification for defining same‐sex sexuality as undesirable and denying LGBT individuals full citizenship. The LGBT community challenges these traditional Christian definitions of same‐sex sexuality in numerous ways, including through the creation of LGBT‐affirming congregations. I examine the development and spread of congregations affiliated with the United Federation of Metropolitan Community Churches (UFMCC), an LGBT‐affirmative denomination, across all 50 states from 1974 to 2000. Drawing upon organizational ecology, resource mobilization, political opportunity, and theories of religious switching, I find that the distribution of UFMCC congregations challenges the usefulness of traditional explanations for activism.