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LGBT individuals have the affectional and/or sexual attraction to a person of the same sex (gay men and lesbians); bisexual individuals are attracted to both sexes and transgender individuals do not identify with their assigned sex at birth.
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There are contradictory attitudes toward LGBT individuals.
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There is an increased acceptance of LGBT individuals (e.g., more states allow same-sex marriage but others do not).
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However, violence and discrimination are pervasive.
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Approximately up to 4-10% of the U.S. population are LGBT.

 Awareness of sexual orientation of gay males and lesbian females tends to occur in the early teens.
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Gender dysphoria (disconnect with the biological sex one is born with) is not the same as sexual orientation.
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Gender dysphoria is still considered a mental disorder.
 Individuals with gender identity issues report feeling different at an early age.
 Cross-sex behaviors and appearance are highly stigmatized in school and society.
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The struggle for identity involves ones internal perceptions in contrast to the external perceptions or assumptions of others about ones sexual orientation.

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The number of openly gay and lesbian individuals has doubled in the past decade (up to 650,000).
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Approximately 1 out of 5 same-sex couples are raising children.
 Still, in most states, same-sex couples cannot marry.
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Children of LGBT couples show healthy cognitive and behavioral functioning. There is no evidence of sexual identity confusion or increased likelihood of displaying same-sex sexual orientation.

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In spite of discrimination, many LGBT individuals show resilience, such as maintenance of hope and seeking social support.
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LGBT individuals are also helped by creating families of choice, serving as positive role models, living authentically, being involved in activism, and enjoying freedom from gender-specific roles.
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LGBT individuals possess more egalitarian relationships.

Coming Out
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The decision to come out can be extremely difficult.
Coming out to parents, family, and friends can lead to rejection, anger, and grief.
This can be especially difficult for adolescents who are financially dependent on their family.
Black and Latino gay and lesbian youth are more reluctant to disclose their sexual orientation than are their White counterparts.
A counselor should help LGBT individuals with the coming out process (e.g., decision making, role plays).
Mental health providers should assist LGBT individuals with acquiring social support.

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More than 94% of LGBT adults report hate crime victimization.
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Cyberbullying and harassment have led to suicides.
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LGBT individuals are subject to heterosexism (e.g., the word gay is equated to stupid).
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Discrimination can lead to depression.
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Bisexual individuals sometimes experience hostility from LG and heterosexual individuals.
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Transgender individuals face being viewed as mentally ill, delusional or self-destructive.
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LGBT individuals face microaggressions.

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 Manifestations of bias include:
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Assuming a client is heterosexual
Believing same-sex orientation is sinful or a form of mental illness
Failure to understand that society’s view of LGBT status is the problem
Focusing on sexual orientation when it is not relevant
Asking clients to renounce sexual orientation
Trivializing LGBT status
Lacking understanding in LGBT identity development
Not understanding impact of internalized negative views
Underestimating consequences of coming out
Misunderstanding importance of intimate relationships
Using a heterosexual framework inappropriately
Presuming LGBT individuals cannot be good parents
Over identifying with LGBT individuals by excessively “understanding.”

 There are 3 million LGBT individuals in the United
States over the age of 65.
 Many are still in the closet and may be reluctant to share with health or government agencies.
 Implications:
 Counselors should help elderly LGBT individuals in gaining access to resources.
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“Project Visibility” is a culturally competent training program for workers in nursing homes.

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Implications for Clinical
Practice
Examine your own views regarding heterosexuality and determine their impact on work with LGBT clients. The way to personalize this perspective is to assume that some of your family, friends, or coworkers may be LGBT.
Read the “Guidelines for Psychotherapy with Lesbian, Gay, and
Bisexual Clients” (Division 44/Committee on Lesbian, Gay, and
Bisexual Concerns, 2000).
Develop partnerships, consultation, or collaborative efforts with local and national LGBT organizations.
Assure that your intake forms, interview procedures, and language are free of heterosexist bias and include a question on sexual behavior, attraction, or orientation.
Do not assume that the presenting problems necessarily are the result of sexual orientation but be willing to address possible societal issues and their role in the problems faced by LGBT clients.

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Implications for Clinical
Practice
Remember that common mental health issues may include stress due to prejudice and discrimination; internalized homophobia; the coming out process; a lack of family, peer, school, and community supports; being a victim of assault; suicidal ideation or attempts; and substance abuse.
Realize that LGBT couples may have problems similar to those of their heterosexual counterparts but may also display unique concerns such as differences in the degree of comfort with public demonstrations of their relationship or reactions from their family of origin.
Assess spiritual and religious needs.

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Implications for Clinical
Practice
Because many LGBT clients have internalized the societal belief that they cannot have long-lasting relationships, have materials available that portray healthy and satisfying LGBT relationships.
Recognize that a large number of LGBT clients have been subject to hate crimes. Depression, anger, posttraumatic stress, and self-blame may result.
For clients still dealing with internalized homosexuality, help them establish a new affirming identity.
Remember that in group therapy, LGBT individuals may have specific concerns over confidentiality and different life stressors compared with their heterosexual counterparts.

Implications for Clinical
Practice
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A number of therapeutic strategies can be useful with internalized homophobia, prejudice, and discrimination. They can include identifying and correcting cognitive distortions, coping skills training, assertiveness training, and utilizing social supports.
If necessary, take systems-level intervention to schools, employment, and religious organizations.
Conduct research on the mental health needs of the
LGBT communities and the effectiveness of current programs.