In June, the Bay Area will come alive with the diversity and visibility of the Gay, Lesbian, Bisexual and Transgendered (GLBT) community. Gay Pride Month, which has also been officially declared "Gay Mental Health Awareness Month" by the San Francisco County Board of Supervisors, gives therapists an opportunity to learn more about the GLBT community, and thus be of more help to our clients. Whether you have clients who are exploring their sexuality, who already identify as gay (or whatever word they choose), or are friends or family members of someone who is GLBT, this is a good time to look at the clinical and community issues which affect many of our clients.

In working with GLBT clients, the inherent homophobia, gender bias and rigidity of the culture at large must be addressed. Many clients may feel an intense pressure to conform to models of life that intrinsically do not fit them. Their attempts to shape themselves to cultural norms can greatly disturb their self-esteem and relationships, both intimate and extended. The client's sexuality probably is not the issue, but their various coping mechanisms and adaptations to society may be. It is important to be sensitive to how easily differences can be seen as inferior or negative, by both ourselves and the individuals with whom we work. This awareness helps to maintain rapport and a positive therapeutic relationship.

GLBT clients present with the same issues in therapy as anyone else. Their issues may be accentuated by real or perceived homophobia. The developmental tasks over the life span are often negatively influenced by minority status. Low self- esteem, shame, guilt, anxiety or depression may mask sexual identity coping issues. Thoughtful questioning by the therapist may reveal the source of the client's struggle. If you work with teenagers and young adults, you already know that identity issues are key. GLBT or questioning youth have higher rates of suicidality because of the potentially lethal mixture of teen angst and homophobia. Alcoholism and drug use must also be looked at in a homophobic context.

Coming out is a lifetime process as new people and situations arise. It can lead to family alienation and/or social isolation. Creating families which are outside the "norm" brings up conflicting feelings around parenting and integrating into the community. Job stress may be heightened and career development may be affected. Health care access or discrimination can be problematic. Seniors may have an especially difficult time finding a place to feel accepted. Assessing for domestic violence is confounded by our notions of gender role conformity and compounded for our clients by even more guilt, shame and confusion.

Many issues that come up with any client are more challenging for a GLBT individual. Conflicting cultural norms, values and beliefs, race, ethnicity, class and disabilities have an additional element when layered over homophobia. There are numerous GLBT groups that identify primarily with minority groups that are a source of support. Many clients may have been brought up in oppressive religious environments and strive as adults to find a more welcoming spiritual practice. Gays are embraced in various religious communities and have created their own institutions and traditions. Therapists should be mindful of all these issues to help clients heal and reintegrate their culture and/or spirituality into their sense of self.

You may work with family members or friends of GLBT individuals who face their own "coming out." You can help clients struggling with their feelings about a GLBT loved one by normalizing the situation and reassuring them that their loved one is not sick or bad. Misconceptions about bisexuality and transgender issues abound. Finding appropriate, accurate information is crucial. Support and educational groups (see PFLAG, below) are immensely helpful, as research has shown that homophobia decreases when a person actually knows someone who is gay.

For your own professional development, you may want to seek out a gay colleague for consultation, or attend any number of public events or drop-in groups. Going to a Pride Parade or finding a gay-focused newspaper helps to increase your comfort level and to stay current on important community issues.

Gaylesta, the Gay Lesbian, Bisexual, Transgender Therapists Association of the Bay Area has 200 members and 100 participants in the Referral Service. We are a professional, non-profit group addressing the diverse needs of our multi-disciplinary members, who represent at least seven counties. Gaylesta, Inc. activities include educational programs, peer consultation groups, a speaker's bureau, social events, a newsletter, a pre-licensed committee, and more. The Referral Service provides confidential referrals and a widely-distributed directory. To obtain more information about Gaylesta, contact our business office at 5337 College Ave #713, Oakland, CA 94618, 510.433.9939, or www.gaylesta.org. Referral Service inquiries: toll free 888.869.4993.

Note: This article reflects the opinions of the author and not necessarily those of
East Bay CAMFT.