Social Work Practice with LGBTQIA Populations

An Interactional Perspective

Claire L. Dente, Claire L. Dente

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781317204541
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Social Work Practice with LGBTQIA Populations provides an overview of key issues for social workers working with LGBTQIA clients. Each chapter considers clients' experiences in different social and interpersonal contexts. This text encourages students to think critically about the barriers and discriminations clients might face in their lives and how social workers can be equipped to address these issues. Students are challenged to develop approaches that extend support to these clients and that remove structural barriers that clients face within the systems they encounter. Utilizing intersectionality theory, students will gain an understanding of the risks and protective factors unique to this population in social work contexts.

1 Introduction

Backgrounds and Assumptions

Claire L. Dente

PH.D., MSW, LCSW

Welcome! It is my desire and that of each chapter contributor that the content in these pages will challenge you to think more deeply about the next LGBTQIA client sitting in front of you, whether or not you are aware of their sexual orientation and gender identity. We bring to you our experience, our passion and our diligent efforts to present what we know and what continues to evolve in a process of lifelong learning. We hope these pages expand your commitment to engage in culturally sensitive social work with LGBTQIA individuals, families, groups, organizations and communities.

Learning Considerations

The purpose of this text is to provide an overview of key issues for LGBTQIA (lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual and ally) clients. Your reading will prepare you to consider the needs of LGBTQIA clients in many different service provision contexts. Overall, this text is not a collection of empirical studies or theoretical essays, although we do share relevant work in theory and research. Rather, the chapter authors invite you to consider the integration of social work knowledge, values and skills with LGBTQIA-specific cultural awareness and sensitivity. This text aims to help you to fill your professional social work “backpack” with more nuanced information about the needs and concerns of the LGBTQIA client in your specific service context. Our goal is to invite you to think critically about how LGBTQIA clients might face barriers and discrimination in the various contexts of their lives. We invite you to develop practice approaches that will extend support through your own encounters with LGBTQIA clients, to utilize a strengths-based approach, to advocate to remove structural barriers and to create policies that support LGBTQIA clients.

Students lead busy lives. Work, family, friends, social media and academic obligations pull us in many directions. We have worked hard to create readable and accessible content for you as a busy student, while maintaining scholarly integrity in the presentation of content. While geared primarily to BSW and MSW students, the content presented here is suitable for all levels of students and practitioners. It will supplement your social work readings that may provide limited content on LGBTQIA issues, yet we hope we will leave you wanting to know more. LGBTQIA cultural awareness is a lifelong learning process. We approach social work practice with LGBTQIA clients broadly, providing an overview of key areas. The contributors present application considerations to engage you in LGBTQIA issues and to assist you in delving more deeply into culturally sensitive service delivery to this population.

A key theme throughout the book is to emphasize the social work knowledge, values and skills needed for the practice of social work with LGBTQIA clients in multiple practice contexts. The contributors approach social work practice with LGBTQIA clients from a strengths perspective and utilizing the construct of intersectionality at micro, mezzo and macro levels. Each chapter begins with a list identifying the recently revised social work competencies found in the Council on Social Work Education’s 2015 Educational Policies (CSWE, 2015) that link with chapter content. These identify where the content will strengthen your social work competence.

Some chapters will include references to case examples to illustrate the application of concepts. Each chapter also provides resources such as relevant organizations and links to their websites, and contributors have bolded important terms defined in a glossary. We hope you will take away “don’t leave home without it” information. Several contributors have also provided practice and discussion questions for you to consider and to test your knowledge.

In developing this text, we were aware that some of you are approaching LGBTQIA-specific practice in a more concentrated manner for the first time, while others may be highly informed. This text introduces some of you to new areas you may not have considered, while providing others a foundation from which to springboard into deeper reflection and more nuanced scholarship. We encourage you to challenge yourself to a new level of competence.

The LGBTQIA population faces unique challenges and concerns. As ecological systems theory postulates, many of these challenges are rooted in the systems where LGBTQIA clients interact. The experiences of oppression, discrimination and privilege for this population are not stagnant. Historical, political, religious and social currents affect the day-to-day experiences of LGBTQIA people. Policies and laws surrounding marriage, adoption and healthcare, as well as the growing acceptance or on-going rejection within many mainstream faith systems touch LGBTQIA people. Thus, addressing LGBTQIA issues is a fluid process in that it must be responsive to political, social, cultural and religious climates. The United States Supreme Court ruled in 2013 that the federal government could not deny marriage benefits to gay and lesbian people, but a ruling on the legality of gay marriage across the country only came from the Supreme Court two years later on June 26, 2015. These rulings instigated a backlash against LGBTQIA people through religious freedom acts, transgender bathroom laws and other discriminatory actions. Federal law still does not list sexual orientation and transgender identity as protected classes, so LGBTQIA people are not afforded the protections that accompany protected class status. This demonstrates that social workers must be proactive about the rights of LGBTQIA people and the delivery of practice.

You will need to be vigilant to pressing needs within each generation. LGBTQIA issues will change and evolve over time within the service contexts presented in these chapters. We hope this content prepares you to address current and emerging issues here and in other contexts of practice not specifically discussed here, such as the military. Most of you who are reading this are interested in learning more, either for professional reasons or because you, a friend or a family member identify with this population. You are most likely highly motivated to learn more about issues relevant to people you know personally. Time and space realities prevent covering all that could be included here. Your reading offers breadth of exposure to the content, and you can choose to delve deeper into each area.

One very important resource for you as a social worker is to know your professional agencies and their positions on important issues. Are you familiar with the National Association of Social Workers, the Council on Social Work Education, the National Association of Black Social Workers, the Association of Baccalaureate Social Work Program Directors and the many other social work groups and organizations that exist? Are you aware that these and other agencies can offer resources, policies and position statements for LGBTQIA-affirmative social work practice? It is important to stay connected while a student and, even more importantly, long after your degrees are completed and you are engaging in social work practice.

Basic Concepts and Foundations

As noted previously, we are exploring LGBTQIA concerns through the frameworks of ecological systems theory, intersectionality and a strengths-based approach. Most social workers learn these concepts through courses on human behavior in the social environment. As a brief reminder, ecological systems theory considers the individual interacting within their environment, taking into consideration micro, mezzo and macro factors. Intersectionality considers the multiple identities of a client (age, gender and gender identity, race, ethnicity, sexual orientation, ability, etc.) and the dynamic and subtle ways these identities might privilege or marginalize an individual or group. A strengths-based approach avoids deficit thinking or blaming the victim and instead focuses on the resources and strengths available to the client.

These models guide our approach in the following chapters. We view LGBTQIA identities from a normative perspective of these identities along a continuum of variation of humanity. Thus, we do not pathologize sexual orientation or gender identity. The American Psychiatric Association removed homosexuality as a disorder from its Diagnostic and Statistical Manual (DSM) in 1973; in 2015, they reframed our understanding of gender in the DSM-5 by replacing Gender Identity Disorder with Gender Dysphoria. You will not find scientific explanations, arguments or justifications for or against a person’s sexual orientation or gender identity here; nor will you find theological debates about the sinfulness of LGBTQIA identities. I do encourage you to explore the nature vs. nurture debate, the studies on “a gay gene,” and the arguments theologians and scholars make pro or con about what the holy readings, spiritual leaders and prophets have to say about sexual orientation and gender identity. While these may be important questions, they often originate from an attempt to seek moral and legal justification for the existence of LGBTQIA people. Justification is not the foundation of this text; rather, we start here from a position of strength, acceptance and normativity. We begin with the belief that for those of us who are believers, the Creator loves us all.

Background and History

There are many identity development models for you to consider as you think about social work practice with LGBTQIA clients. While we do not go into depth about them here, researchers consider Cass’s Homosexual Identity Formation Model a milestone in understanding identity (Cass, 1979). Chapters 7 and 9 will include discussion of additional models for you to consider. Other researchers extend these theories and develop new applications relevant for current generations and contexts (Dickey, Burnes & Singh, 2012; Kenneady & Oswalt, 2014). What other models have you learned that help to frame our understanding of LGBTQIA identity and development?

As you consider social work practice with LGBTQIA clients, consider what you know about LGBTQIA history. In addition to the removal of homosexuality and gender identity disorder from the DSM, there are many markers in the history and experiences of LGBTQIA people. What happened to LGBTQIA people in the Holocaust? What do you know about Stonewall? Where did symbols like the rainbow flag and pink triangle originate? Can you identify the other LGBTQIA flags and symbols? What do you know about the HIV/AIDS crisis, breast cancer and healthcare for transgender people? How have religious traditions approached sexual orientation and gender identity? In what ways have LGBTQIA people challenged oppression and pursued civil rights? What is the history of gay marriage, how have LGBTQIA people been treated in schools or the military, and how has the media evolved in LGBTQIA representation? The following chapters will answer some of these questions with you; for others we challenge you to explore on your own.

Terminology and Language: Defining LGBTQIA

It is important to remember about whom we are speaking when we use the LGBTQIA acronym. Definitions and language are important to LGBTQIA people. The following explanations are extremely basic and will seem insufficient and incomplete to most LGBTQIA people. It is always important for us to get to know our clients and to ask them how they identify.

To define simply, lesbians (L) are women attracted to women, gay men (G) are men attracted to men and bisexual people (B) can be attracted to men or to women. Transgender (T) people are individuals who may identify internally as a gender other than that presented by their biology from birth (see Chapter 8 for more intricate definitions). Queer (Q) is an umbrella term, formerly a derogatory slur against LGBTQIA people, reclaimed by some to reframe its original meaning and to provide an inclusive space. It can include anyone who identifies as LGBTQIA, gender non-binary (those who do not identify gender as consisting solely of two traditional options of male or female), pansexual (those who may be attracted to members of all gender identities and expressions) and gender non-conforming (those who do not adhere to societal expectations and rules regarding gender expectations and presentation). Questioning (Q) refers to individuals who are exploring or unsure of their sexual orientation and/or gender identity. Individuals with intersex (I) conditions, also referred to as Disorders/Differences of Sex Development (DSD), are individuals with “congenital conditions in which development of chromosomal, gonadal, or anatomic sex is atypical” (Accord Alliance, 2018; Chavhan et al., 2008, p. 1893; Houk, Hughes, Ahmed & Lee, 2006). It is important to know that some of these individuals prefer not to be included under the LGBTQIA umbrella, while others do. Individuals who identify as asexual (A) tend not to be sexually attracted to others, but there are many nuances and depths to this identity that could challenge that assertion. Historically, allies (A) are heterosexual (men attracted to women; women attracted to men) and cisgender (individuals whose internal gender identity matches their external biology) individuals who support LGBTQIA people. It is important to be aware that LGBTQIA people vary greatly in their use of terminology, and that terminology evolves. We aimed for greater inclusion by using the broad LGBTQIA umbrella, while humbly recognizing that even this may over- or under-represent, and that not all content in every chapter applies to all populations.

Terminology and Language: Clarifying Concepts

Now that we know ‘who’s who,’ let us examine ‘what’s what.’ I am grateful to Dr. Rodney Mader and Dr. Jackie Hodes at West Chester University of Pennsylvania (with thanks to Jason Stansberry, Dr. Rita Drapkin of Indiana University of Pennsylvania, and the West Chester University of Pennsylvania LGBTQ Advocacy Committee). Their tireless efforts developed ally training content that discussed biological sex, gender identity, gender role and expression, sexual orientation, sexual behavior and sexual identity (Mader & Hodes, 2009). Sometimes these concepts can be confusing, so let us take a closer look at their subtle distinctions.

Biological sex refers to the body with which I was born. It consists of my chromosomes, genitalia and hormones. The majority of individuals are born with a biological sex that we know as male or female, which is why society often considers gender to be binary (having only two options). Yet, others are born with atypical presentation or conditions (DSD and/or intersex) that do not fall neatly into these categories. Gender identity refers to my internal sense of my gender. This could be male, female, transgender, genderqueer, or perhaps I do not find any of these appropriate and thus might identify as label free. Gender role or expression captures how I choose to present myself outwardly. Do I wear extremely feminine or masculine clothing, or present with traditionally gender-specific hairstyles, mannerisms, gestures or make-up? If you research LGBTQIA history you can find discussions of butch/femme, drag and androgyny, but gender expression is also important today. How do members of our society treat individuals who do not fit traditional gender roles and expression? When does society find this acceptable or not? A man wearing a skirt might turn heads in one context, yet be viewed as normative in another context, especially if that dress is a kilt and it is March 17 in New York City. Thus, social norms influence our understanding.

Sometimes there is confusion between gender and sexuality, but these concepts differ. My sexual orientation indicates to whom I am attracted physically, emotionally and sexually. Heterosexual/straight people are attracted to the “opposite sex” while gay/lesbian people are attracted to the “same” sex. As noted earlier, there are also people who do not fit neatly into these categories, such as those who identify as asexual, bisexual, pansexual, queer or label free. My sexual behavior is the activity I choose to engage in and with whom. One might identify as a lesbian but engage in sexual behavior such as heterosexual intercourse with a close male friend, perhaps even a gay male friend. Social workers need to remember that identity and behavior may appear contradictory; thus, it is important to avoid presumptions. Finally, my sexual identity involves how I view myself. An individual might question if the lesbian or gay man mentioned earlier are bisexual, as each engaged in traditionally heterosexual behavior, yet each clearly self-identifies as lesbian and gay. It is important to listen to our clients about their identities.

Your Journey in the Pages Ahead

As you read the chapters ahead, you will find some common threads across chapters. This should highlight for you the importance of certain historical event...