Analysis of the Counselling Service Provision for LGBTQIA-POC

Summary

The client group I have chosen for this assignment is Lesbian, Gay, Bisexual and Transgender- People of Colour (LGBTQIA-POC). In this assignment, I will be using the acronym LGBTQIA to represent individuals who identifies as lesbian, gay, bisexual, transgender, queer/questioning, intersex or asexual. People of Colour (POC) is a term used to describe individuals from non-white or non-Caucasian backgrounds/ethnicities (Jackson, 2006).

Common Presenting Issues

According to Meyer (2003), stigma, prejudice and discrimination often create hostile and stressful environments that may cause mental health problems for minorities. LGBTQIA-POC are likely to experience social and psychological issues that are a bit different from those that affect heterosexual ethnic/racial minority individuals or White queers (Akerlund & Cheung, 2000).

As LGBTQIA-POC belong to more than one minority group, they may face multiple challenges in a society which often only accepts heterosexuality as an acceptable orientation, and in which people of colour often experience negative social outcomes (Cyrus, 2017; Sutter& Perrin, 2016). Although there is research that shows LGBTQIA identifying individuals have an increased risk for mental health problems and individuals who face racism experience psychological distress, there is very little study done on the intersectionality of these identities and the resulting effects of multiple discrimination on mental health (Ross, 2017; Russell & Fish, 2016).

LGBTQIA-POC are at greater risk to experience mental health related problems as the heterosexist stigma is much more prevalent within communities of colour than in White communities (Battle & Lemelle, 2002; Conron et al., 2015; Garnets, 2002; Green, 2000; Lemelle & Battle, 2004; Parks, Hughes, & Matthews, 2004; Parks, 2005). Research suggests that due to the racial, ethnic and/or cultural variations in norms, values, attitudes and beliefs regarding sexuality and gender identity of both minority and mainstream cultures, individuals from the LGBTQIA-POC community are more likely to experience a significant amount of psychological stress that could affect their physical and mental health (Diaz, Ayala, Bein, Henne, & Marin, 2001; Harper & Schneider, 2003; Meyer, 2003; Greene, 1997; Manalansan & Martin, 1996).

Studies show that LGBTQIA-POC are subjected to multiple forms of micro aggressions and these individuals often experience unique stressors associated with their dual minority status (Balsam, Molina, Beadnell, Simoni, & Walters, 2011; Sutter et al., 2016). Along with facing cumulative discrimination and social exclusion, LGBTQIA-POC also face racism within the LGBTQIA communities, heterosexism within the ethnic minority communities and racial/ethnic discrimination in dating and close relationships (Ferguson, Carr, & Snitman, 2014; Kudler, 2007; Brown, 2008; Han, Proctor, & Choi, 2014). Some studies also found that LGBTQIA-POC are more likely to be objectified and sexualized by some White LGBTQIA individuals who want to fulfil their exotic fantasies/fetishes (Balsam et al., 2011; Han, 2007; Jones, 2010; Nabors et al., 2001).

Moradi et al. (2010) suggested that because of the inherent conflict and/or differences between ethnic/racial and LGBTQIA identities, the identities of White LGBTQIA individuals have been often construed as different from the identities of the LGBTQIA-POC. Furthermore, due to the intersection of the individual components of these identities, the subsequent identity formed is likely to be more complex, with risk of competition for saliency, conflict over incongruent values and beliefs, and unique lived experiences that are not fully understood by either group (Balsam et al., 2011; Khan, Illcisin, & Saxton, 2017).

A study by McQueeney (2009) suggested that LGBTQIA-POC rely more on their ethnic/racial communities than on LGBTQIA communities. This may lead to these individuals endorsing their racial/ethnic communities over their sexual and/or gender identities, thus leading to internalized homophobia and/or concealment of their sexual identity and/or gender (Moradi et al., 2010; Szymanski & Gupta, 2009; Ward, 2005).

Studies have found that internalized stigma (used here as an umbrella term for internalized transphobia/genderism and internalized homophobia/heterosexism) is associated with a variety of psychological distress like demoralization, helplessness, depression, anxiety, hopelessness, psychosomatic symptoms, low self-esteem, confused thinking, feelings of guilt, sexual problems, suicidal behaviours and AIDS-related psychological distress (Barnes & Meyer, 2012; Moradi et al., 2010; Newcomb & Mustanski, 2010; Rosser, Bockting, Ross, Miner, & Coleman, 2008; Quinn et al., 2015; Szymanski & Gupta, 2009). Therefore, individuals identifying as LGBTQIA-POC are more likely to experience these mental health related problems as well.

To avoid potential discrimination within their ethnic community, some individuals choose to conceal their sexual orientation and/or non-conforming gender identity (Frost, 2011). Concealment of one’s sexual orientation often leads to lower self-esteem, social isolation, mental health problems, substance use, suicide and high-risk behaviours (Ceballos-Capitaine et al., 1990; Frost & Bastone, 2007; Meyer, 2003). A study by Khan et al. (2017) predicted a positive correlation between multifactorial discrimination and poor mental health. The study found that individuals from ethnic/racial background identifying as LGBTQIA were associated with risk factors for severe depression, chronic stress, low self-esteem, anxiety and aggregated mental health scores (Khan et al., 2017).

Some of the typical presenting problems that LGBTQIA individuals who are racial, ethnic and cultural minorities may experience include suicide ideations, depression, generalized anxiety, social anxiety, chronic stress, lower self-esteem, alcohol and substance abuse, identity crises, post-traumatic stress disorder, relationship problems and engagement with risky behaviour (Cochran, Mays, Alegria, Ortega, & Takeuchi, 2007; Consolacion, Russell, & Sue, 2004; Dubé & Savin-Williams, 1999; Sutter & Perrin, 2016). Other forms of marginalization related to factors such as age, geographical location, immigration status, English language proficiency, acculturation status, social class and disability (Bieschke, Hardy, Fassinger, & Croteau, 2008; Kertzner, Meyer, Frost, & Stirratt, 2008; Rosario, Schrimshaw, & Hunter, 2004).

Characteristics of Client Group

Individuals who are share one or more variables such as race/ethnicity, gender, age, religion, sexuality and social class are also generally more likely to share similar characteristics with each other (McPherson, Smith-Lovin, & Cook, 2001). LGBTQIA-POC are usually at a high risk of suffering from legal failures such as inadequate workplace protection and unequal pay, along with health and wealth disparities which results in them facing high poverty rates and economic insecurity (Taylor, 2015; Ward, 2008). Due to these barriers, individuals identifying within this group often find it difficult to financially provide for themselves and/or their families (Taylor, 2015). Individuals belonging to this client group are also more likely to face homelessness.

Studies show that due to discrimination related to identifying as LGBTQIA in ethnic/racial communities, many adolescents are either thrown out of their homes by their families or they runaway due to the fear of being abused/mistreated at home (Page, 2017; Reck, 2009).

It is argued that LGBTQIA-POC are often pressured into concealing their sexual orientation due to fear or being discriminated against by their racial/ethnic communities (Aranda et al., 2015; Harper, Jernewall, & Zea, 2004; Rosario et al., 2004). A study by Moradi et al. (2010) suggests that LGBTQIA-POC are more likely to demonstrate greater resilience and experience lower mental health problems than LGBTQIA individuals who are from White Caucasian backgrounds. It is possible that LGBTQIA-POC may have learned more ways of coping with discrimination aimed at their sexuality or gender as people of colour are more likely to have experiences in dealing with discrimination based on their ethnicity or race (Cochran et al., 2007; Kertzner et al., 2008; Meyer, Dietrich, & Schwartz, 2009; Moradi et al., 2010; Singh & McKleroy, 2011).

Another factor that plays an important role is language, whether it is verbal or non-verbal, spoken or written, it is one of the most important tools in communicating successfully, and often individuals who have grown up in non-English speaking countries often have a challenging time communicating (verbally or non-verbally) in western countries that predominantly speak English (Ikeda & Tidwell, 2009; Spencer-Rodgers & McGovern, 2002).

People of colour who identify as individuals belonging to the LGBTQIA community, typically do not access counselling services due to many reasons. One of the reasons why individuals from this client group may be reluctant to access counselling services, especially ones specific to the LGBTQIA community, may result from the LGBTQIA stigma prevalent in their racial/ethnic communities, and fear of being seen near these services (Frost, 2011). It is also possible that LGBTQIA-POC are more likely to come from ethnic minority communities where there is a high level of stigma attached to mental illness, which is why individuals from these groups choose not to seek out help from mental health services (Gary, 2005).

As most services cost money, individuals from low income and financially instable families may not be able to afford the mental health services that may contribute to the decreased likelihood of this group seeking out counselling services (Taylor, 2015; Ward, 2008). Although there may be services available that offer counselling at a lower cost or sometimes even for free, individuals from this group are more likely to not be aware of these resources available to them (Sawrikar, 2016).

Another reason why LGBTQIA-POC are less likely to access mental health care providers is because they have difficulty finding services that are sensitive to both LGBTQIA and race/ethnicity issues (Balsam et al., 2011). Studies show that mental health practitioners often fail to incorporate this group’s ethno-cultural worldview and/or their socio-political realities as they often frame LGBTQIA-POC within Eurocentric and heterosexual paradigms (Fukuyama & Ferguson, 2000).

Therefore, LGBTQIA-POC are less likely to approach mental health services even when they are in need of support and/or assistance, as they are more likely to experience alienation from counsellors and other mental health providers (Gitterman & Sideriadis, 2001; Stone, 2003; Wynn & West-Olatunji, 2009).

Steps that can be taken to Improve Access to Counselling Services

Stigma towards metal illness and seeking help from mental health services is one of the most cited reasons why people prefer not to seek mental health treatment (Corrigan, 2004). One way in which the service and wider community can help lower the stigma of mental illness in the LGBTQIA-POC community is by designing educational programs targeted towards these populations to help them understand the causes and negative impacts of experiencing mental health issues while also reducing the stigma barriers.

People of colour identifying as LGBTQIA may also feel more comfortable approaching services that have counsellors from various ethnic/racial backgrounds who also identify as LGBTQIA (Robinson-Wood, 2016; Wynn et al., 2009). Hence, organizations and services that provide counselling for LGBTQIA individuals or individuals from multicultural backgrounds should also employ counsellors that their client group (LGBTQIA-POC) can identify with.

These services could also inform their client group population that they provide counselling for individuals from both, LGBTQIA and ethnic/racial minority communities, as LGBTQIA-POC are often confused or not aware about which counselling service they can seek out for treatment. As mentioned before, LGBTQIA-POC are more likely to face poverty and financial instability, hence it would be helpful if services that cater to this population either provide low cost or free counselling services to individuals who cannot afford it.

It is also important for counsellors who work within this client group population to provide interventions that are not only appropriate for LGBTQIA clients, but that are also culturally and racially appropriate as empirical research indicates that although LGBTQIA individuals of colour share similar experiences of being ethnical/racial minorities, in regards to the risks for negative mental health consequences they are not a homogeneous group across race/ethnicity (Harper et al., 2004).

As individuals from ethnical/racial minorities are more likely to be non-native English speakers, counselling services should provide clients with translators if needed and/or provide them with counsellors who can speak their language (Walsh, 2014). Furthermore, due to the discrimination against LGBTQIA individuals in many ethnic/racial communities, services that provide counselling for LGBTQIA-POC should also provide their client group with internet and/or telephone counselling that is anonymous, as it would not only help their client group feel safe, but could also be helpful for the individuals who face difficulties in accessing services (Abbott et al., 2014).

Available Service for LGBTQIA-POC

Although there are many services that cater to the LGBTQIA community, there are no organizations in Victoria that have services specific for LGBTQIA-POC. Switchboard Victoria Inc. (2017) is a non-profit organization that provides peer based and volunteer run support services for LGBTQI people and their families, friends and allies. They also provide online and telephone counselling services to LGBTQIA identifying people and their families.

This organization has recently started a project called ‘Everybody Under the Rainbow” which aims to improve understanding and support for LGBTQIA people of colour and/or Indigenous people by using approaches taken from Racial Literacy and Anti-racist organizations to improve their services. They are hoping that through this they can better their understanding about the LGBTQIA community from ethnic/racial communities and provide better services to them. Although their service doesn’t provide counselling specifically for LGBTQIA-POC, the organization does have counsellors who are trained in multicultural counselling and/or LGBTQ affirmative therapy.

Ethical and Legal Issues

LGBTQIA-POC come from religious backgrounds where there is still stigma about LGBTQIA sexualities and/ or gender (Washington, 2001). Due to the still prevalent biases and misinformation about non-conforming sexual identities and/or genders in these communities, LGBTQIA-POC are more likely to seek help to change their sexual orientation (Tozer & Hayes, 2004). This may lead to not only ethical but also legal issues for counsellors as conversation therapy is banned in Victoria, Australia (Health Complaints Act, 2016). Sexual and physical abuse is higher amongst LGBTQIA-POC, and counsellors may face various ethical and legal dilemmas around reporting sexual and physical abuse cases (Balsam, Lehavot, Beadnell, & Circo, 2010; Harper et al., 2004; Stotzer, 2009).

Ethically and legally, counsellors are required to report all cases of child abuse/violence, but depending on the client’s age and family situations, reporting this to authorities may be a bit complicated if the clients are around the ages of 15 or older and/or reporting may cause them more difficulties. If a client is a minor i.e. below the age of 18 years, the counsellor may be ethically and legally required to keep the client’s parents informed about the process by sharing information about the sessions, but this could prove to be challenging if the client is an older teenager (14 years and above) who has sufficient understanding and intelligence to fully understand their circumstances and make their own decisions. Hence, informing the client’s parents about their child’s sexual/gender identity could get complicated as it can be unethical to go against the client’s (the child’s) wishes, especially if they do not want their parents to know, and depending on their family circumstances (family and cultural beliefs around LGBTQIA) it can sometimes cause them more harm than good.

Counsellors may also overgeneralize their client’s problems based on their ethnicity, race or cultural and sexual identity and/or gender, and may fail to understand the challenges that integration of multiple identities could pose for their LGBTQIA-POC clients (Balsam et al., 2011; Fukuyama et al., 2000; Haldeman, 2012). As the LGBTQIA-POC community is niche population, various confidentiality issues and ethical dilemmas may arise (Koocher & Keith-Spiegel, 2013; Lonborg & Bowen, 2004).

The counsellor is likely to experience confidentiality and boundary issues if a client starts to talk about another client that also comes to the service for therapy or maybe even someone who the counsellor may know outside of work really well. Another challenge that a counsellor might face often is transference and countertransference. The counsellor is likely to respond to their client’s transference with unhealthy and/or harmful countertransference if their own boundaries are not firm (Howard, 2000).

Specific Training that Might be Helpful or Necessary

Training in culture-centered therapy and gay (LGBTQIA) affirmative therapy might be helpful and even necessary when working with clients from LGBTQIA-POC populations (Davies, 1996; Arredondo, McDavis, & Sue, 1992). When working with LGBTQIA-POC, counsellors should have knowledge and understanding of the non-heterosexual and non-Eurocentric worldviews as well as an awareness about the socio-political realties of LGBTQIA life, to be able to provide effective counselling to this client group (Wynn et al., 2009).

The intersection of ethnic, racial and/or cultural identities with sexual and/or gender identities often present distinctive problems that require cultural knowledge when accessing and intervening with LGBTQIA individuals who are from ethnically diverse communities (Israel & Selvidge, 2003; Wynn et al., 2009). Studies show that training in culture-centered counselling can help provide counsellors with a framework that can accurately conceptualize the presenting issues of ethnically/racially diverse clients, leading to positive outcomes (Israel & Selvidge, 2003; Wynn & West-Olatunji, 2008; Wynn et al., 2009).

As most individuals’ identities and perspectives on mental health issues are formed based on their cultural orientation, using the culture-centered counselling approach with diverse LGBTQIA clients would help provide counsellors with an alternative framework that would not only help them conceptualize their client’s needs, but also facilitate appropriate interventions for their clients (Sue & Sue, 2008; Wynn et al., 2009).

Studies show that training in gay (LGBTQIA) affirmative therapy has helped mental health professionals who may be subjected to biases and prejudices about LGBTQIA culture because of the heterosexist society they live in, clarify their negative attitudes about non-heterosexual orientations while also positively enhancing their knowledge and skills (Boysen & Vogel, 2008; Israel & Hackett, 2004; Mathews, 2007; Rutter, Estrada, Ferguson, & Diggs, 2008). Affirmative therapy can be used to address the negative impacts that homophobia, transphobia and heterosexual may have on LGBTQIA clients while also helping them embrace a positive view of their identities, sexualities and relationships (Bigner & Wetchler, 2012).

Critical Discussion

Although, most of these studies focus on LGBTQIA-POC, there are some limitations that need to be taken into account when generalizing and interpreting their findings. Most of the sample sizes were not sufficient to examine the differences between race/ethnicity as well as gender and/or sexual identity in relation to experiences of discrimination and its effect on mental health. There was also little to no research done on how socio-economic status and/or age would affect the individuals presenting issues.

It is also apparent that there is limited empirical research on LGBTQIA-POC and that most of the published studies related to this population are only theoretical in nature. Moreover, it is possible that individuals who participated in these studies may differ in more systemic ways from those who did not participate.

For example, participating individuals may be more open about their sexualities, more aware of the stigma they face or may even be more connected to LGBTQIA communities, and hence these factors may limit the generalizability of the findings.

Additionally, the probability of being able to determine a generalized explanation of how discrimination and stress can affect mental health outcomes is low, as the LGBTQIA-POC has a significant amount of diversity within the group itself. Sample composition should also be taken into account when interpreting the generalizability of the research findings.

Most of the studies had samples composed of adolescents, young adults and adults and African-Americans, Latin-Americans and very few Indians and Chinese, hence further research would be needed to be able to evaluate the applicability of the results to LGBTQIA-POC from other ethnicities/races and age groups (for e.g. Individuals from Japan, Pakistan, etc. and children and older adults).

Similarly, these studies also had limited representation of individuals who identified as bisexual, asexual, intersex, pansexual or Indigenous Australian. Lastly, as most of these studies were conducted on populations in America, there may be a difference in the presenting issues of the LGBTQIA-POC in Australia, due to cultural and social differences between America and Australia.

Personal Reflection

As a pansexual Indian, I do identify with the LGBTQIA-POC client group. Identifying with a client group can have both benefits and drawbacks for the counsellor. One of the benefit’s is that ethnically similar clients may feel that I can relate to their circumstances and issues and also understand their problems better as they may assume that shared commonalities in cultures and values are important elements in minority mental health (Zane et al., 2005).

Clients who share the same ethnicity as me may also feel that they can express themselves better as I would be able to better understand their non-verbal (body) language. As I am multi-lingual, clients who speak the same language as me may feel more comfortable as they can express their feelings in their language, especially if their English language proficiency is not good. Belonging to a multiple minority group, I would be able to better understand the discrimination that LGBTQIA-POC experience in LGBTQIA communities and also their own ethnic/racial communities, and this knowledge would help me counsel them more efficiently.

However, I could also over identify with LGBTQIA Indians and their problems which could hinder the therapeutic relationship and lead to inefficient counselling. Over identifying with a client could lead to countertransference and transference possibilities. Although I am a minority, I still may not be able to identify with all minorities, as each ethnicity, race and/or culture are very different from each other and so are their issues and problems (Modood, 2013).

Due to the various biases and prejudices prevalent within the racial/ethnic minority and LGBTQIA communities, I may stereotype my clients or they may come into counselling with stereotypes about me, a non-heterosexual Indian female (Hagendoorn, 1995). This may lead to some transference and countertransference which could disrupt the client-counsellor relationship.

For example, I may have a client from African ethnicity who identifies as gay and due to the pre-existing stereotypes I may have about gay African men, I may unconsciously transfer my feelings and thoughts onto him and this could lead to him reacting negatively to my misplaced emotions or visa-versa. As sexuality is very complex and everyone understands it differently, I may also face challenges in trying to keep my emotions in check when a client’s opinions and understanding of sexuality and gender it is very different from mine (Harper et al., 2013).

Another kind of transference that would be problematic is erotic transference. If a client is facing relationship problems, it is possible that he/she may develop fantasies about their therapist, i.e. me, that are romantic, intimate and/or sexual (Devi, Manjula, & Math, 2015; Milton, Coyle, & Legg, 2005).

To work with this client group, I would need to do additional training in multicultural and LGBT affirmative therapy. I also think it would be helpful to have additional education, training and experience in areas such as:

(a) multidimensional models of human sexual orientation;

(b) effects of stigmatization on LGBTQIA-POC;

(c) career and workplace issues experiment by LGBTQIA-POC;

(d) types of non-traditional relationships and families;

(e) challenges with religion, spirituality and culture for LGBTQIA-POC;

(f) effects of intersection of multiple identities, i.e. sexual orientation, race, ethnicity and culture, gender, social class, and disability.

References

Abbott, J. A. M., Klein, B., McLaren, S., Austin, D. W., Molloy, M., Meyer, D., & McLeod, B. (2014). Out & Online; effectiveness of a tailored online multi-symptom mental health and wellbeing program for same-sex attracted young adults: study protocol for a randomised controlled trial. Trials, 15(1), 504.

Akerlund, M., & Cheung, M. (2000). Teaching beyond the deficit model: Gay and lesbian issues among African Americans, Latinos, and Asian Americans. Journal of Social Work Education, 36(2), 279-292.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author

Aranda, F., Matthews, A. K., Hughes, T. L., Muramatsu, N., Wilsnack, S. C., Johnson, T. P., & Riley, B. B. (2015). Coming out in color: Racial/ethnic differences in the relationship between level of sexual identity disclosure and depression among lesbians. Cultural Diversity and Ethnic Minority Psychology, 21(2), 247-257.

Arredondo, P., McDavis, R., & Sue, D. W. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Multicultural Counseling and Development, 20(2), 64–89.

Balsam, K. F., Lehavot, K., Beadnell, B., & Circo, E. (2010). Childhood abuse and mental health indicators among ethnically diverse lesbian, gay, and bisexual adults. Journal of Consulting and Clinical Psychology, 78(4), 459.

Balsam, K. F., Molina, Y., Beadnell, B., Simoni, J., & Walters, K. (2011). Measuring Multiple Minority Stress: The LGBT People of Color Microaggressions Scale. Cultural Diversity & Ethnic Minority Psychology, 17(2), 163–174. http://doi.org/10.1037/a0023244

Barnes, D. M., & Meyer, I. H. (2012). Religious affiliation, internalized homophobia, and mental health in lesbians, gay men, and bisexuals. American Journal of Orthopsychiatry, 82(4), 505-515.

Battle, J., & Lemelle, A. J. (2002). Gender differences in African American attitudes toward gay males. Western Journal of Black Studies, 26, 134-139

Bieschke, K. J., Hardy, J. A., Fassinger, R. E., & Croteau, J. M. (2008). Intersecting identities of gender-transgressive sexual minorities. Biennial review of counseling psychology, 1, 177-207.

Bigner, J. J., & Wetchler, J. L. (Eds.). (2012). Handbook of LGBT-affirmative couple and family therapy. Routledge.

Boysen, G.A., & Vogel, D.L. (2008).  The relationship between level of training, implicit bias, and multicultural competency among counselor trainees.  Training and Education in Professional Psychology, 2, 103-110.

Brown, C. E. (2008). Racism in the gay community and homophobia in the Black community: Negotiating the gay Black male experience.

Ceballos-Capitaine, A., Szapocznik, J., Blaney, N. T., Morgan, R. O., Millon, C., & Eisdorfer, C. (1990). Ethnicity, emotional distress, stress-related disruption, and coping among HIV seropositive gay males. Hispanic Journal of Behavioral Sciences, 112, 135–152.

Chen and Georgiana Shick Tryon, Y. C. (2012). Dual minority stress and Asian American gay men’s psychological distress. Journal of Community Psychology, 40(5), 539-554.

Cochran, S. D., Mays, V. M., Alegria, M., Ortega, A. N., & Takeuchi, D. (2007). Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults. Journal of Consulting and Clinical Psychology, 75(5), 785-794.

Conron, K., Wilson, J., Cahill, S., Flaherty, J., Tamanaha, M., & Bradford, J. (2015). Our health matters: Mental health, risk, and resilience among LGBTQ youth of color who live, work, or play in Boston. Boston, MA: The Fenway Institute.

Consolacion, T. B., Russell, S. T., & Sue, S. (2004). Sex, Race/Ethnicity, and romantic attractions: Multiple minority status adolescents and mental health. Cultural Diversity & Ethnic Minority Psychology, 10(3), 200-214. doi:http://dx.doi.org.ezproxy.lib.monash.edu.au/10.1037/1099-9809.10.3.200

Corrigan, P. (2004). How stigma interferes with mental health care. American psychologist, 59(7), 614.

Cyrus, K. (2017). Multiple Minorities as Multiply Marginalized: Applying the Minority Stress Theory to LGBTQ People of Color. Journal of Gay & Lesbian Mental Health, (just-accepted), 00-00.

Davies, D. (1996). Towards a model of gay affirmative therapy.

Devi, K. D., Manjula, M., & Math, S. B. (2015). Erotic Transference in Therapy with a Lesbian Client. Ann Psychiatry Mental Health, 3(3), 1029.

Diaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. American journal of public health, 91(6), 927.

Dominguez, M. L. (2017). LGBTQIA people of color: Utilizing the cultural psychology model as a guide for the mental health assessment and treatment of patients with diverse identities. Journal of Gay & Lesbian Mental Health, 1-18.

Dubé, E. M., & Savin-Williams, R. C. (1999). Sexual identity development among ethnic sexual-minority male youths. Developmental psychology, 35(6), 1389.

Ferguson, A. D., Carr, G., & Snitman, A. (2014). Intersections of race-ethnicity, gender, and sexual minority communities. In Handbook of race-ethnicity and gender in psychology (pp. 45-63). Springer New York.

Frost, D. M. (2011). Social stigma and its consequences for the socially stigmatized. Social and Personality Psychology Compass, 5(11), 824-839.

Frost, D. M., & Bastone, L. M. (2007). The role of stigma concealment in the retrospective high school experiences of gay, lesbian, and bisexual individuals. Journal of LGBT Youth, 5(1), 27–36.

Fukuyama, M. A., & Ferguson, A. D. (2000). Lesbian, gay, and bisexual people of color: Understanding cultural complexity and managing multiple oppressions. In R. M. Perez, K. A. DeBord, & K. J. Bieschke (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients (pp. 81–105). Washington, DC: American Psychological Association.

Garnets, L. D. (2002). Sexual orientations in perspective. Cultural Diversity and Ethnic Minority Psychology, 8, 115-129.

Gary, F. A. (2005). Stigma: Barrier to mental health care among ethnic minorities. Issues in mental health nursing, 26(10), 979-999.

Ghabrial, M. A. (2017). “Trying to Figure Out Where We Belong”: Narratives of Racialized Sexual Minorities on Community, Identity, Discrimination, and Health. Sexuality Research and Social Policy, 14(1), 42-55.

Ginicola, M. M., Smith, C., & Filmore, J. M. (Eds.). (2017). Affirmative Counseling with LGBTQI+ People. John Wiley & Sons.

Gitterman, A., & Sideriadis, L. (2001). Social work practice with vulnerable and resilient populations. Handbook of social work practice with vulnerable and resilient populations, 1-38.

Greene, B. (1997). Ethnic minority lesbians and gay men: Mental health and treatment issues. In B. Greene (Ed.), Psychological perspectives on lesbian and gay issues: Vol. 3. Ethnic and cultural diversity among lesbians and gay men (pp. 216-239). Thousand Oaks, CA: Sage Publications. (Reprinted in modified form from “Journal of Consulting and Clinical Psychology,” 1994, 62, pp. 243–251)

Greene, B. (2000). African American lesbian and bisexual women. Journal of Social Issues, 56, 239-249.

Hagendoorn, L. (1995). Intergroup biases in multiple group systems: The perception of ethnic hierarchies. European review of social psychology, 6(1), 199-228.

Haldeman, D. (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. Am Psychol, 67(1), 10-42.

Han, C. S. (2007). They don’t want to cruise your type: Gay men of color and the racial politics of exclusion. Social Identities, 13(1), 51-67.

Han, C. S., Proctor, K., & Choi, K. H. (2014). We pretend like sexuality doesn’t exist: Managing homophobia in Gaysian America. The Journal of Men’s Studies, 22(1), 53-63.

Harper, A., Finnerty, P., Martinez, M., Brace, A., Crethar, H. C., Loos, B., … & Travis, L. (2013). Association for lesbian, gay, bisexual, and transgender issues in counseling competencies for counseling with lesbian, gay, bisexual, queer, questioning, intersex, and ally individuals. Journal of LGBT Issues in Counseling.

Harper, G. W., & Schneider, M. (2003). Oppression and discrimination among lesbian, gay, bisexual, and transgendered people and communities: A challenge for community psychology. American journal of community psychology, 31(3-4), 243-252.

Harper, G. W., Jernewall, N., & Zea, M. C. (2004). Giving voice to emerging science and theory for lesbian, gay, and bisexual people of color. Cultural Diversity and Ethnic Minority Psychology, 10(3), 187.

Health Complaints Act 2016 (Vic.) No. 22 of 2016 (Austl.). Retrieved from http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/PubStatbook.nsf/51dea49770555ea6ca256da4001b90cd/6984F85370CAF903CA257FA80016089A/$FILE/16-022aa%20authorised.pdf

Howard, A. (2000). What can philosophy offer counselling and psychotherapy?. British Journal of Guidance and Counselling, 28(3), 411-419.

Ikeda, J., & Tidwell, C. (2009). Cultural Differences in Non-verbal Communication. Vermont Department of Health.

Israel, T., & Hackett, G.  (2004). Counselor education on lesbian, gay, and bisexual issues:  Comparing information and attitude exploration.  Counselor Education and Supervision, 43, 179-191.

Israel, T., & Selvidge, M. (2003). Contributions of multicultural counseling to counselor competence with lesbian, gay, and bisexual clients. Journal of Multicultural Counseling and Development, 31(2), 84-98.

Jackson, Y. (Ed.) (2006). Encyclopaedia of multicultural psychology Thousand Oaks, CA: SAGE Publications Ltd. doi: 10.4135/9781412952668

Jones, K. E. (2010). “I only date guys that who look like me”: A study of race and sexuality in Chicagos LGBT community. Roosevelt University.

Kertzner, R. M., Meyer, I. H., Frost, D. M., & Stirratt, M. J. (2009). Social and Psychological Weil‐Being in Lesbians, Gay Men, and Bisexuals: The Effects of Race, Gender, Age, and Sexual Identity. American Journal of Orthopsychiatry, 79(4), 500-510.

Khan, M., Ilcisin, M., & Saxton, K. (2017). Multifactorial discrimination as a fundamental cause of mental health inequities. International journal for equity in health, 16(1), 43.

Koocher, G. P., & Keith-Spiegel, P. (2013). Boundary Crossings and the Ethics of Multiple Role Relationships.

Kraus, K. L. (2008). Lenses: applying lifespan development theories in counseling. Boston, Mass, Lahaska Press.

Kudler, B. A. (2007). Confronting race and racism: Social identity in African American gay men (Doctoral dissertation).

Lemelle, A. J., & Battle, J. (2004). Black masculinity matters in attitudes toward gay males. Journal of Homosexuality, 47(1), 39-51.

Lonborg, S. D., & Bowen, N. (2004). Counselors, communities, and spirituality: Ethical and multicultural considerations. Professional school counseling, 318-325.

Manalansan, I. V., & Martin, F. (1996). Double minorities: Latino, Black, and Asian men who have sex with men.

Mathews, C.R.  (2007). Affirmative lesbian, gay, and bisexual counseling with all clients.  In K.J. Bieschke, R.M. Perez, & K.A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed.). (pp. 201-219).  Washington, DC: American Psychological Association.

McLaughlin, K. A., Hatzenbuehler, M. L., & Keyes, K. M. (2010). Responses to discrimination and psychiatric disorders among Black, Hispanic, female, and lesbian, gay, and bisexual individuals. American journal of public health, 100(8), 1477-1484.

McPherson, M., Smith-Lovin, L., & Cook, J. M. (2001). Birds of a feather: Homophily in social networks. Annual review of sociology, 27(1), 415-444.

Meyer, D. (2015). Violence against queer people: Race, class, gender, and the persistence of anti-LGBT discrimination. Rutgers University Press.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological bulletin, 129(5), 674.

Meyer, I. H. (2010). Identity, stress, and resilience in lesbians, gay men, and bisexuals of color. The Counseling Psychologist, 38(3), 442-454.

Meyer, I. H., Dietrich, J., & Schwartz, S. (2008). Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations. American journal of public health, 98(6), 1004-1006.

Milton, M., Coyle, A., & Legg, C. (2005). Countertransference issues in psychotherapy with lesbian and gay clients. European Journal of Psychotherapy & Counselling, 7(3), 181-197.

Modood, T. (2013). Multiculturalism. John Wiley & Sons, Ltd.

Moradi, B., Wiseman, M. C., DeBlaere, C., Goodman, M. B., Sarkees, A., Brewster, M. E., & Huang, Y. (2010). LGB of color and white individuals’ perceptions of heterosexist stigma, internalized homophobia, and outness: Comparisons of levels and links. Counseling Psychologist, 38(3), 397-424. Retrieved from https://search-proquest-com.ezproxy.lib.monash.edu.au/docview/742869278?accountid=12528

Murphy, J. and R. Hardaway (2017). “LGBTQ adolescents of color: Considerations for working with youth and their families.” Journal of Gay & Lesbian Mental Health 21(3): 221-227.

Nabors, N. A., Hall, R. L., Miville, M. L., Nettles, R., Pauling, M. L., & Ragsdale, B. L. (2001). Multiple minority group oppression: Divided we stand?. Journal of the Gay and Lesbian Medical Association, 5(3), 101-105.

Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical psychology review, 30(8), 1019-1029.

Page, M. (2017). Forgotten Youth: Homeless LGBT Youth of Color and the Runaway and Homeless Youth Act. Nw. JL & Soc. Pol’y, 12, 17-92.

Parks, C. A., Hughes, T. L., & Matthews, A. K. (2004). Race/ethnicity and sexual orientation: Intersecting identities. Cultural Diversity and Ethnic Minority Psychology, 10(3), 241-254. DOI: 10.1037/1099-9809.10.3.241

Parks, C. W. (2005). Black men who have sex with men. In J. L. Chin (Ed.), The psychology of prejudice and discrimination: Bias based on gender and sexual orientation, Vol. 3 (pp. 227-248). Westport, CT: Praeger/Greenwood.

Pedersen, P. B. (1991). Multiculturalism as a generic approach to counseling. Journal of Counseling & Development, 70(1), 6-12.

Quinn, K., Dickson-Gomez, J., DiFranceisco, W., Kelly, J. A., Lawrence, J. S., Amirkhanian, Y. A., & Broaddus, M. (2015). Correlates of internalized homonegativity among black men who have sex with men. AIDS Education and Prevention : Official Publication of the International Society for AIDS Education, 27(3), 212–226. http://doi.org/10.1521/aeap.2015.27.3.212

Reck, J. (2009). Homeless gay and transgender youth of color in San Francisco: “No one likes street kids”—Even in the Castro. Journal of LGBT Youth, 6(2-3), 223-242.

Robinson-Wood, T. (2016). The convergence of race, ethnicity, and gender: Multiple identities in counseling. Sage Publications.

Rosario, M., Schrimshaw, E. W., & Hunter, J. (2004). Predictors of substance use over time among gay, lesbian, and bisexual youths: An examination of three hypotheses. Addictive behaviors, 29(8), 1623-1631.

Ross, C. E. (2017). Social causes of psychological distress. Routledge.

Rosser, B. S., Bockting, W. O., Ross, M. W., Miner, M. H., & Coleman, E. (2008). The relationship between homosexuality, internalized homo-negativity, and mental health in men who have sex with men. Journal of homosexuality, 55(2), 185-203.

Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual review of clinical psychology, 12, 465-487.

Rutter, P.A., Estrada, D., Ferguson, L.K., & Diggs, G.A. (2008).  Sexual orientation and counselor competency: The impact of training on enhancing awareness, knowledge, and skills.  The Journal of LGBT Issues in Counseling, 2, 109-125.

Sawrikar, P. (2016). Working with Ethnic Minorities and Across Cultures in Western Child Protection Systems. Taylor & Francis.

Singh, A. A., & McKleroy, V. S. (2011). “Just Getting Out of Bed Is a Revolutionary Act” The Resilience of Transgender People of Color Who Have Survived Traumatic Life Events. Traumatology, 17(2), 34-44.

Spencer-Rodgers, J., & McGovern, T. (2002). Attitudes toward the culturally different: The role of intercultural communication barriers, affective responses, consensual stereotypes, and perceived threat. International Journal of Intercultural Relations, 26(6), 609-631.

Stone, C. B. (2003). Counselors as advocates for gay, lesbian, and bisexual youth: A call for equity and action. Journal of Multicultural Counseling and Development, 31(2), 143-155.

Stotzer, R. L. (2009). Violence against transgender people: A review of United States data. Aggression and Violent Behavior, 14(3), 170-179.

Sue, D. W., & Sue, D. (2012). Counseling the culturally diverse: Theory and practice. John Wiley & Sons.

Sue, D. W., Ivey, A., & Pederson, P. (1996). Multicultural counseling and therapy. Pacific Grove, CA: Brooks/Cole.

Sutter, M., & Perrin, P. B. (2016). Discrimination, mental health, and suicidal ideation among LGBTQ people of color. Journal of Counseling Psychology, 63(1), 98. Retrieved from https://search-proquest-com.ezproxy.lib.monash.edu.au/docview/1765612725?accountid=12528

Switchboard Victoria. (2017). Welcome – Switchboard Victoria. [online] Available at: http://www.switchboard.org.au/ [Accessed 23 Oct. 2017].

Szymanski, D. M., & Gupta, A. (2009). Examining the relationship between multiple internalized oppressions and African American lesbian, gay, bisexual, and questioning persons’ self-esteem and psychological distress. Journal of Counseling Psychology, 56(1), 110.

Taylor, M. (2015, 23 April). Report: LGBT people of color at high risk of poverty. Al Jazeera America. Retrieved from http://america.aljazeera.com/articles/2015/4/23/lgbt-people-of-color-more-likely-to-face-poverty.html

Tozer, E. E., & Hayes, J. A. (2004). Why do individuals seek conversion therapy? The role of religiosity, internalized homonegativity, and identity development. The counseling psychologist, 32(5), 716-740.

Walsh, S. D. (2014). The bilingual therapist and transference to language: language use in therapy and its relationship to object relational context. Psychoanalytic Dialogues, 24(1), 56-71.

Ward, E. G. (2005). Homophobia, hypermasculinity and the US black church. Culture, health & sexuality, 7(5), 493-504.

Ward, J. (2008). White normativity: The cultural dimensions of whiteness in a racially diverse LGBT organization. Sociological Perspectives, 51(3), 563-586.

Washington, P. (2001). Who gets to drink from the fountain of freedom? Homophobia in communities of color. Journal of Gay & Lesbian Social Services, 13(1-2), 117-131.

Wynn, R., & West-Olatunji, C. (2008). Culture-centered case conceptualization using NTU psychotherapy with an African-American gay male client. Journal of LGBT Issues in Counseling, 2(4), 308-325.

Wynn, R., & West-Olatunji, C. (2009). Use of culture-centered counseling theory with ethnically diverse LGBT clients. Journal of LGBT Issues in Counseling, 3(3-4), 198-214.

Zane, N., Sue, S., Chang, J., Huang, L., Huang, J., Lowe, S., … & Lee, E. (2005). Beyond ethnic match: Effects of client–therapist cognitive match in problem perception, coping orientation, and therapy goals on treatment outcomes. Journal of Community Psychology, 33(5), 569-585.