QUEERING UP: NEEDS ASSESSMENT FOR SENSITIVITY TRAINING FOR
GRADUATE STUDENTS OF SOCIAL WORK REGARDING SEXUAL AND
GENDER MINORITIES
A Thesis
Presented to the faculty of the Division of Social Work
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SOCIAL WORK
by
Janice A. Stanley
SPRING
2013
QUEERING UP: NEEDS ASSESSMENT FOR SENSITIVITY TRAINING FOR
GRADUATE STUDENTS OF SOCIAL WORK REGARDING SEXUAL AND
GENDER MINORITIES
A Thesis
by
Janice A. Stanley
Approved by:
________________________________, Committee Chair
Chrys C. Ramirez Barranti, PhD., MSW
______________________________, Second Reader
David K. Nylund, LCSW, Ph.D
Date___________________________
ii
Student: Janice A. Stanley
I certify that this student has met the requirements for format contained in the University
format manual, and that this thesis is suitable for shelving in the Library, and credit is to
be awarded for this thesis.
_________________________, Graduate Coordinator __________________
Dale Russell, Ed.D., LCSW
Date
Division of Social Work
iii
Abstract
of
QUEERING UP:
NEEDS ASSESSMENT FOR SENSITIVITY TRAINING FOR GRADUATE
STUDENTS OF SOCIAL WORK REGARDING SEXUAL AND GENDER
MINORITIES
by
Janice A. Stanley
Sexual and gender minorities continue to face many challenges in today’s environment.
Minority stress, concerns of coming out, gender identity, transition, and family and work
environment are all reasons that the LGBTQ community seeks therapy. Graduate-level
social work education has placed an importance on cultural humility, especially when it
comes to racial and ethnic minorities. What is lacking in the curriculum is sensitivity
training regarding sexual and gender minorities. The LGBTQ community is a stigmatized
population in a heteronormative society and as such its members are often vulnerable or
at risk. Without valuable sensitivity training, the newly graduated social worker often
feels unprepared to explore sensitive issues with their LGBTQ clients.
_________________________________, Committee Chair
Chrys C. Ramirez Barranti, Ph.D., MSW
__________________________
Date
iv
TABLE OF CONTENTS
Page
List of Tables …………………………………………………….…………………...…vii
Chapter
1. INTRODUCTION………………………………………………………………….…..1
Background of the Problem ………………………………………………………8
Statement of the Research Problem ........................................................................ 9
Purpose ………………………………………………..…………………10
Theoretical Framework ……………………………………………….…11
Definition of Terms …………………………………………………...…14
Assumptions …………………………………………..…18
Justification ……………………………………………...19
Limitations ………………………………………………19
Summary ……………………………………………………………………….. 20
2. LITERATURE REVIEW….......……………………………………………………...21
Theory and Social Constructs …………………………………………………...22
Creating a Culturally-Competent Space for LGBTQ Clients …………...30
Social Work Education Regarding the LGBTQ Population …………….32
Incorporation of Professional Mental Health Services ………………….40
Summary ………………………………………………………………………...51
3. METHODS ……………….…………………………………………………………..53
Study Design …………………………………………………………………….53
v
Sampling Procedures ……………………………………………………………54
Data Collection Procedures ……………………………………………………...55
Measurement Instruments ……………………………………………………….56
Data Analysis ……………………………………………………………………57
Protection of Human Subjects …………………………………………………. 58
Summary ………………………………………………………………….……. 58
4. OUTCOMES …………………………………………………………………………59
Overall Findings ………………………………………………………………...59
Specific Findings ………………………………………………………………..60
Summary ……………………………………………………………………….. 76
5. CONCLUSION, SUMMARY, AND RECOMMENDATIONS ……………………. 77
Summary of Study ………………………………………………………………77
Implications for Social Work ................................................................................ 79
Recommendations. .................................................................................... 83
Limitations ………………………………………………………………83
Conclusions ………………………………………………………………...........85
Appendices ………………………………………………………………………………87
Appendix A. Assessing the Diversity Competency Needs of MSW II Graduate
Students in Working with LGBTQ Persons ………...……………..88
Appendix B. Consent to Participate in Research……….………………………..95
References ……………………………………………………………………………….97
vi
LIST OF TABLES
Tables
Page
1. Exposure to classes that taught sensitivity to LGBTQ populations .............................. 60
2. Exposure to classes that taught sensitivity to LGBTQ populations
during internship ........................................................................................................... 60
3. Exposure to clients who have questioned their sexual orientation ............................... 61
4. Preparedness to respond to clients who are questioning their sexual orientation ......... 61
5. Comfort with responding to clients who are questioning their sexual orientation ....... 61
6. Exposure to clients who have questioned their gender presentation ............................ 62
7. Preparedness to respond to clients who are questioning their gender presentation ...... 62
8. Comfort with responding to clients who are revealing their sexuality or choice of
gender ........................................................................................................................... 62
9. Exposure to clients who are Lesbian, Gay, Bisexual, or Transgender ......................... 63
10. Preparedness to respond to clients who reveal their sexuality or choice of gender .... 63
11. Comfort in responding to clients who reveal their sexuality or choice of gender ...... 64
12. Confidence in knowledge of issues and needs of LGBTQ clients.............................. 64
13. Preparedness to assist clients with issues regarding sexuality and gender ................. 65
14. Exposure during 204A/B coursework to course content about the needs and issues
of the LGBTQ community .......................................................................................... 65
15. Exposure during 204C/D coursework to course content about the needs and issues
of the LGBTQ community ………………………………………..…………………66
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16. Satisfaction in graduate social work courses with the addressing of topics related to
issues and needs of LGBTQ community .................................................................... 66
17. Opinion on need for strengthening of LGBTQ issues and needs educational content
in MSW program ........................................................................................................ 66
18. Receptivity to participating in training that taught sensitivity to issues and needs of
LGBTQ clients ............................................................................................................ 67
19. Perception of need for more information about the needs of LGBTQ clients ............ 67
20. Willingness to work with clients who are Lesbian, Gay, Bisexual, or
Transgender................................................................................................................. 67
21. Receptivity to supporting and advocating for LGBTQ clients ................................... 68
22. Preference of working with specific target population for second-year
MSW students ............................................................................................................. 68
23. Preference between specific training regarding their target population or
writing a thesis ............................................................................................................ 68
24. Preparedness to work with target population based on depth of study of target
population ................................................................................................................... 69
25. Exposure to queer theory ............................................................................................ 69
26. Exposure to works of Judith Butler ............................................................................ 70
27. Exposure to works of Adrienne Rich .......................................................................... 70
28. Exposure to works of Michel Foucault ....................................................................... 70
29. Understanding of BDSM ............................................................................................ 70
30. Understanding of queer ............................................................................................... 71
viii
31. Understanding of MTF ............................................................................................... 71
32. Understanding of Poly ................................................................................................ 71
33. Understanding of pegging ........................................................................................... 72
34. Understanding of cis gender ....................................................................................... 72
35. Understanding of gender queer ................................................................................... 72
36. Understanding of cross dresser ................................................................................... 72
37. Understanding of transsexual...................................................................................... 73
38. Understanding of two spirit ........................................................................................ 73
39. Understanding of bi gender ......................................................................................... 73
40. Understanding of asexual............................................................................................ 74
41. Understanding of FTM ............................................................................................... 74
42. Understanding of gender blenders .............................................................................. 74
43. Understanding of third sex .......................................................................................... 74
44. Understanding of pansexual........................................................................................ 75
45. Understanding of FFS ................................................................................................. 75
46. Understanding of stealth ............................................................................................. 75
47. Understanding of HRT ................................................................................................ 75
48. Understanding of SRS................................................................................................. 76
ix
1
Chapter 1
INTRODUCTION
Throughout our culture’s history, oppression has marginalized many communities
of people, with the queer community being one of the most commonly targeted groups.
For the purpose of this paper, queer will be defined as anything outside the binary
categorization of male/female and heterosexuality/homosexuality. Socially constructed
bi/gender roles and heteronormativity have made it arduous at best to present as queer.
According to Rudy (2000), “Being queer is not a matter of being gay, then, but rather of
being committed to challenging that which is perceived as normal” (p.197). More specific
to the transgender and transsexual population, which has nothing to do with
homosexuality, the Institute of Medicine (2011) describes gender nonconformity as the
extent to which a person’s gender identity, role, or expression differs from the cultural
norms set forth for people of a particular sex. It has been hypothesized that being queer
was considered pathological and social workers have treated their clients with this
perception. Transgender socio/political status has historically been similar to that of gays
and lesbians. Platt (2000),
Until the 1960’s, most social workers, psychiatrists, and psychologists
treated homosexuality as an aberration and indication of abnormal
development. For most of the history of the US, homosexuals have faced
practices that range from murder to ostracism—being denied the right to
marry, adopt children or share benefits. (p.2)
2
Current literature and studies demonstrate that being queer is not
indicative of the need for psychiatric care, nor is it pathological. Dr. David
Nylund (in a personal communication, April 12, 2012) states that there is little to
no empirical research regarding level of competencies with LGBTQ concerns
amongst graduate students of Social Work. The literature review supported the
fact that there has been little research done regarding graduate students’ and
therapists’ lack of knowledge in regards to working with sexual and gender
minorities. As stated by Mackelprang, Ray & Hernandez-Peck, 1996 (as cited in
Gezinski, 2009), LGBTQ issues are not sufficiently included in social work
education. It should be noted, however, that in Garnet’s work (as cited in Butler,
2009), it was estimated that 99% of therapists will see at least one sexual or
gender minority (SGM) client during their careers. Also noted by McFarlane and
King (as cited in Butler, 2009), SGM people are dissatisfied with mental health
treatment services, in which they experience prejudice, discrimination and overt
homo- and trans-phobia.
The National Association of Social Workers (NASW) has been in existence since
1955. Their Code of Ethics was developed in an effort to define working ethical
boundaries for licensed social workers. The NASW Code of Ethics, under Section 1.05,
titled Cultural Competence and Social Diversity, states that
(c) Social Workers should obtain education about and seek to
understand the nature of social diversity and oppression with respect to
race, ethnicity, national origin, color and sex, sexual orientation, age,
3
marital status, political belief, religion, immigration status and mental or
physical disability. (NASW, 2008, p. 1)
Furthermore, section 4.02 in the NASW code of ethics states that “Social Workers
should not practice, condone, facilitate, or collaborate with any form of discrimination on
the basis of race, ethnicity, national origin, color, sex, sexual orientation, age, marital
status, political belief, religion or mental or physical ability. Social workers have an
obligation to advocate and defend clients against any forms of discrimination” (NASW,
2008, p. 1).
The Educational Policy and Accreditation Standards have set certain educational
guidelines and policy for social work students, with the policies providing guidelines
regarding social work educational programs, and the standards providing an
understanding of the basic premises of social work education. Section 2.1.4-Engage
diversity and difference in practice, lists the following four agreements that students must
comprehend and use as a guide. (Council on Social Work Education, 2010, pp. 4-5)

Recognize the extent to which a culture’s structures and values may oppress,
marginalize, alienate, or create or enhance privilege and power;

Gain sufficient self-awareness to eliminate the influence of personal biases and
values in working with diverse groups;

Recognize and communicate their understanding of the importance of difference
in shaping life experiences; and

View themselves as learners and engage those with whom they work as
informants.
4
Reviewing such powerful documents has lead this researcher to question how and
why students and practitioners continue to feel ill prepared when it comes to working in
direct practice with sexual and gender minorities. Recently updated models, such as Gay
affirmative therapy, sexual and gender minority therapy, and systemic practice have
better defined the standards for practice and guidelines for professionals. In 2011, both
the American Psychological Association (APA) and Standards of Care (SOC) updated
their practice guidelines pertaining to transgender standards of health care. Both included
changes of practice and guidelines for treatment of queer populations. The Association
for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC) also
updated their guidelines and approach. The collective (Burns et al., 2009), in an effort to
make positive changes, proposed to use a strengths-based approach, highlighting the
strength and resilience of the queer population. These recent updates were brought forth,
by and large, through clinicians’ recognition of the need for a more updated, nonpathological approach when working with LGBTQ persons.
The LGBTQ community does face many unique and challenging stressors, often
leading them to seek out professional therapy. As presented by Meyers (2003), there is
stigma attached to gender nonconformity in many societies around the world. Such issues
can lead to prejudice and discrimination, resulting in “minority stress.” As described by
The Institute of Medicine (2011), minority stress is unique (in addition to the general
stressors experienced by all people), socially based, and chronic, and may make
transgender and gender non-conforming individuals much more vulnerable to developing
mental health concerns such as anxiety and depression. Gender nonconformity may
5
adversely affect lifestyle, work relations, family relations, and even education. The
reasons these individuals seek therapy include depression, anxiety, gender exploration,
coping with external stressors, and transition. Psychotherapy may assist with issues
regarding enhanced decision-making, gender identity, sexual identity, and can help
individuals explore options for living a queer life.
Gender nonconformity is a matter of diversity—not pathology—and therefore
carries a unique set of needs that may be addressed in therapy. McPhail (2004) explained,
“by labeling homosexuality as a separate category, distinct from heterosexuality, the
medical and scientific communities have been able to label such behavior and lifestyles
as perverse, deviant and abnormal” (p.8). As described by Lev (2005), The Diagnostic
and Statistical Manual of Mental Disorders (DSM) evokes some questioning when
including:
Gender Identity Disorder within the official diagnostic nosology of mental
disorders is a controversial topic that involves many questions about the
role of the psychiatric establishments in the labeling of those who violate
societal norms, particularly norms involving sex and gender issues (p. 36).
The “System of Care Policy” (SOC) is a document provided by the World
Professional Association for Transgender Health (WPATH). WPATH was officially
founded in 1979 and is an international nonprofit organization. The Organization is
devoted to advancing educational knowledge on issues related to gender health and
identity. WPATH members include professionals from multiple professional disciplines.
6
Representatives include but are not limited to the medical field, psychology,
anthropology, education, sociology, and social work.
The SOC, a 120-page document, has established ethics and guidelines that pertain
to the care of patients with gender identity disorders. The World Professional Association
for Transgender Health (2011) states that “these internationally accepted guidelines are
designed to promote the health and welfare of persons with gender identity disorders.”
Issues addressed in the SOC, as stated by The Human Rights Campaign (2011) are:

Gender dysphoria;

Improvement in the medical and psychological treatment of transgender
individuals;

Social and legal acceptance of hormonal and surgical sex reassignment; and

Professional and public education on the phenomenon of Transgender.
WPATH issued their first “Standards of Care” articulated document in 1979. This
was the same year that the group was founded. Since 1979, WPATH has released seven
total Standards of Care documents. The target population addressed in the SOCs
comprises “Transsexual, Transgender and Gender Non-Conforming People.” (p. 1)
Past versions of the SOC have recognized the Transgender population to be
suffering mental disorders similar to those experienced by Lesbians and Gays. The newly
revised SOC has demonstrated that not all transgendered people will experience gender
dysphoria. Gender dysphoria was used in the past to describe a possible mental illness
diagnosis amongst the transgender community. The 7th version of the SOC states that it is
7
possible for clients to experience gender dysphoria, but for the most part, they consider
“non-conformity” as the preferred descriptive, as it is a term that brings no emphasis on a
mental illness condition. “Gender non-conformity refers to the extent to which a person’s
gender identity, role, or expression differs from the cultural norms prescribed for people
of a particular sex” (Institute of Medicine, 2011). The SOC continues to say, “only some
non-conforming people experience gender dysphoria at some point.” (p. 5)
This section continues to mention that those suffering from gender dysphoria can
seek treatment. Seeking some form of professional therapy can help a person to discover
a gender role with which they are comfortable. Treatment can be in the form of
counseling, cross-dressing, or a possible full transition with hormones and medical
treatment. In conclusion to this section, perhaps the most liberating statement written in
the SOC is,
Some people experience gender dysphoria at such a level that the distress
meets criteria for a formal diagnosis that might be classified as a mental
disorder. Such a diagnosis is not a license for stigmatization or for the
deprivation of civil and human rights. Existing classification systems such
as the Diagnostic Statistical Manual of Mental Disorders (DSM)
(American Psychiatric Association, 2000) and the International
Classification of Diseases (ICD) (World Health Organization, 2007)
define hundreds of mental disorders that vary in onset, duration,
pathogenesis, functional disability, and treatability. All of these systems
attempt to classify clusters of symptoms and conditions, not the
8
individuals themselves. A disorder is a description of something with
which a person might struggle, not a description of the person or the
person’s identity. (p. 5)
Although transsexual people still receive treatment under the paradigm of the
psychiatric model’s category of gender identity disorder, as noted by the DSM IV-TR,
they soon will be liberated from such labeling in the forthcoming DSM 5, which seems to
be evidence that the movement for gender identity reform is building. However, the
degree of trans-competency among social work practitioners may remain low and lag
behind other competencies.
Background of the Problem
According to many of the professional documents described above, the need for
more updated best practice guidelines is crucial, especially because there is currently a
movement away from pathologizing this population. Documents regarding mental health
practices with the LGBTQ population that are available to students and researchers
further exemplify this need for updated guidelines. The history of and the critical need for
updated versions reaching MSW student’s classrooms define a clear imperative.
In addition to direct prejudice and discrimination, institutionalized oppression
against queers has been significant. As explored by McPhail (2004), social work practice
has largely adopted an oppression model in its research, practice, education, policy, and
advocacy work, which can at times reify institutionalized prejudices against queers. She
also notes that labels of identity have been socially constructed and are based on ideas of
9
group membership. While these paradigms have shaped social work practice, policy and
pedagogy, they can be problematic even as they are simultaneously politically useful
(McPhail, 2004). This paper demonstrates the necessity for further qualitative research in
order to update the model and platform for a modern queer theory, and the need for
updated sexual and gender education for graduate students and licensed social workers.
Statement of the Research Problem
There currently exists a deficiency of research and updated best practice
education for graduate students regarding policy and practice when working with the
LGBTQ community. As noted by Mally and Takser (as cited in Butler, 2009), of concern
is the fact that the majority of systemic therapists receive very little training, if any, on
how to work with sexual and gender minority clients. Considering how frequently the
topics of homosexuality and gender non-conformity are discussed and debated, it seems
only appropriate for those who are mental health professionals to have a basic
understanding and knowledge of this realm of cultural diversity. Diversity topics that
should be included are sexual orientation, gender non-conformity, and the effects of a
homophobic and heterosexist society in an ecological context: to include a person’s
mental, emotional, and physical well-being. A practitioner lacking knowledge of what it
means to be Gay, Lesbian, Bisexual or Transgender, or absent of a basic understanding of
the guidelines for working with this community, can in no way provide adequate or
ethical mental health services or treatment for these clients.
10
Purpose. The current world makes it, at best, difficult for most to live outside of
the majority of culturally constructed norms. Institutionalized sexism, racism, and
classism create considerable barriers for those who do not fit into specific categories or
definitions. Missing from graduate level education regarding LGBTQ competency, as
explored by Mackelprang et al., 1996 work (as cited in Gezinski, 2005), is the failure to
incorporate sexual orientation alongside race, ethnicity, and gender when considering a
client’s identity.
Heterosexism systematically privileges those who have a heterosexual identity
while concurrently oppressing those who identify as gay, lesbian or bisexual. It is
essential that curriculum that addresses the history our constructivist environment be
paired with the crucial deconstruction of what has been status quo, should be examined
by all graduate students. The significance of a rejection of such binaries that create sexual
and gender minorities as “other,” should be emphasized in the curriculum of graduate
level of social work, which would highlight the importance of a culturally-competent
curriculum framework to prepare social work students to work with the LGBTQ clients.
The likelihood is high that social work students will interact with LGBTQ clients
at some point during the course of their career. It should be noted that in Garnet’s work
(as cited in Butler, 2009), it is estimated that 99% of therapists will see at least one sexual
or gender minority (SGM) client during their careers; however, as noted in Hylton’s work
(as cited in Gezinski, 2005), the fact still remains that colleges of social work often fail to
incorporate LGBTQ material into programs of study. The purpose for this research is to
demonstrate that, not only does the graduate-level curriculum lack queer theory and
11
specialized LGBTQ training, but that the graduate students themselves desire more
knowledge regarding this population of potential clients.
The second—and perhaps most relevant—reason for interest in this research has
been brought forth by this writer’s MSW I internship at the Gender Health Center (GHC)
in Sacramento. The internship at the GHC allowed the researcher the privilege to work
directly with seven clients. Six out of seven of the clients had sought out therapy in the
past and all six of them, through verbal communication, were not happy with the services
they received. Their situations could be have been different: since gender and sexual
theory is evolving rapidly, students and practicing social workers must be skilled on the
most recent changes in language, best practices, and cultural humility of LGBTQ
persons.
Theoretical framework. The theoretical framework that is most relevant to this
subject matter is queer theory. Queer theory is a comparatively new thought genre, which
ignited from the post-structural movement of the early 1990s, filling in the gaps and
modifying the disparities of feminist theory. It is illuminating that earlier forms of
feminism imparted the idea that one should retreat into private separatist domains in
order to protect what was special to womanhood, where as queer theory attempts to
deconstruct the institutions that perpetuate injustice (Rudy, 2000, p.196).
The basic presupposition of queer theory poses an argument against what is
viewed as normal within the constructs of our society and attempts to deconstruct the
social and cultural practices that construct normality. Essentially, queer theory attempts
to clarify or demonstrate the social constructs that are perceived as normal in our society,
12
attempting to make the familiar strange (Oswald, et al., 2009). Oswald et al. (2009)
continue to explore the values that are rooted in these normal constructions. Queer theory
critiques Lesbian-Gay (LG) theory as being somewhat limited and linear, providing no
room for bi-sexuality. Bi-sexuality in LG theory is considered a path traveled while one
is emerging as being gay. Social constructionists immediately protested and criticized the
limitations of this thought. The timing and synthesis of the need for sexual freedom and
expression gave way to queer theory.
Queer theory is successful at recognizing, as Oswald et al. (2009) point out, that
the world is composed of restricted categories and labels that create power relations.
These categories include linguistic binaries of heterosexual/homosexual, which in turn
create the foundation for the normal vs. deviance paradigm. “Deviance” is derived from
what is not the center. Queer theory challenges that which is the center. For
deconstruction purposes, queer theorists investigate the rewards and power gathered by
those individuals, communities, and institutions that benefit from the hetero norm.
Like feminist theory, much of the discourse of queer theory is derived from a
political or activist movement. Both theories recognize that both gender and sexuality are
performed in context; both theories also include other social identities such as class and
race.
Queer theory is remarkable in that it allows us to deconstruct or even to see with a
clear lens, that which has been constructed by society. Oswald et al. (2009) explores the
issue of social practices that construct the “normality” and leads us to question the values
embedded in such constructions. These authors argue that social workers in both the
13
macro and micro workplace need to understand the sexual and gender binaries that have
been constructed by society. Crawly and Broad as cited in Oswald et al. (2009) state that
queer theory conceptualizes the world as being falsely bounded and constructed of
categories that imply permanence and a lack of fluidity. The article continues to support
the argument that our society is based upon power and social control, with heteronormativity being what our society views as the center. The difficulty in social work
practice is to integrate knowledge while also challenging the idea that heterosexuality is
the norm and anything other than that would be seen as deviant. Oswald et al. (2009)
challenge us to question how the center was constructed and how we as social workers
can clarify this for our clients in practice. Queer theory demonstrates to the practitioner
and the client a sense of strength, once the social construction of the binary is pointed out.
Oswald et al. (2009) essentially argue that hetero-normativity pushes us to reject
the model that fuses together gender ideology, family ideology and sexual ideology as
one theory. Queer theorists push us to observe family, gender and sexuality as
interdependent. By supporting the hetero norm, we are allowing our clients to risk
rejection by society, family members, friends and community. Queer theory is essential
knowledge that any social worker practicing within the LGBTQ community should
know. It is, as Oswald et al. (2009) point out, a postmodern approach in which identity is
fluid and contextual. The closing arguments to this article include a macro-level approach
to creating classifications that are more inclusive. The implications of queer theory and
social work education is summarized best by Logan (as cited in Fish, 2008), who argues
14
that social work students need access to knowledge of theories of oppression,
disadvantage, and discrimination in relation to sexuality and gender.
Definition of terms. The definition of terms specific to this research project and
the LGBTQ community have been adapted from the Gender Health Center Training
Materials: How to be a Transgender Ally (Glossary of Terms), prepared by the Gender
Health Center, Sacramento, California (2012).
Asexual: Persons with little to no sexual attraction to others.
BDSM: Bondage, discipline, sadism, and masochism or, dominance and
submission.
Bi Gender: One who feels that his or her gender is both fully male and fully
female.
Biocentrism: The assumption that people whose assigned sex at birth matches
their gender identity throughout their lives are more “real” and/or more “normal” than are
those whose assigned sex at birth is incongruent with their gender identity. It’s similar to
heterosexism, but focuses on gender rather than sexual orientation.
Bisexual: Females and males that have emotional and sexual attraction to both
genders.
Cisgender: Persons whose gender identity, gender expression, and gender role are
considered socially appropriate for people of their sex at birth. In other words, persons
who are comfortable with the gender they are born.
15
Cross dresser: A currently preferred term for what was formerly known as
transvestite. Cross dressers enjoy wearing clothes and utilizing the accouterments that are
typically considered appropriate for the opposite sex.
Cross Dressing: The act of wearing clothes and accessories that generally are
associated with those of the opposite sex. Does not mean transgender.
Gay: A male that has primary emotional and sexual attraction to other males.
Gender: How one perceives one’s self, (gender identity) and how one wants to
demonstrate gender to others (gender expression). The most common gender identities
are ‘man’ and ‘woman’, with many variations included under the umbrella terms trans or
transgender.
Gender Binary: The concept that everyone must be one of two genders: either
man or woman.
Gender Blender: A Person who blends both masculine and feminine together in
their physical presentation.
Gender Dysphoria: The feeling of anguish and anxiety that arises from the
mismatch between a trans person’s physical sex and their gender identity; and from
parental and societal pressure to conform to gender norms.
Gender Expression: How one demonstrates one’s gender to others through
clothing, social roles, and language. It is often described in a polarity of ‘feminine’ or
‘masculine’.
16
Gender Identity: One’s internal and psychological sense of one’s gender. The
most common gender identities are ‘man’ or ‘woman’, with many other variations
included in the umbrella of terms trans and transgender..
Gender-non-conforming: Behaving in a way that does not match social
stereotypes about female or male gender, usually through dress or physical appearance.
Gender Norms: Inherently tied to other cultural norms relating to ethnicity, class,
physical ability, and age. Whether one is perceived by others as a man or woman,
masculine or feminine, depends on how your gender expression and physical
characteristics “fit” with preconceived perceptions of other attributes one possesses.
Genderqueer: A term used by some people who may or may not identify as
transgender, but who identify their gender as somewhere on the continuum beyond the
binary male/female gender system.
Heterosexual: Individuals who have primary emotional and sexual attraction with
persons of the opposite gender.
Homophobia: Negative feelings toward those perceived to be Lesbian, Gay,
Bisexual, or Transgender. Homophobia may be expressed through negative feelings and
can lead to discrimination, violence, and crimes of hate that may stem from irrational
fear.
Lesbian: A female who has primary emotional and sexual attraction to other
females.
17
Physical Transition: A change in the way a person presents themselves in their
social environment and daily life. Transition usually involves a change in physical
appearance, behavior, and /or identification.
FSF: Facial feminization surgery.
FTM: Describes a direction of gender transition from female to
male.
HRT: Hormone replacement therapy.
MTF: Describes a direction of gender transition from male to
female.
Nonoperative: A term that is generally used to indicate a trans
person who has not had surgery or taken hormones to support a physical
transition.
Preoperative: A term that is generally used to indicate a trans
person who is taking steps toward surgeries to support their transition.
Postoperative: A terms that is generally used to indicate a trans
person is seeking who has had surgery or surgeries to support their
transition.
Sex Reassignment Surgery (SRS): The generic term for any and all
medical surgeries that are part of the transition process.
Poly: Having two or more lovers.
Queer: Anything outside the binary categorization of male/female and
heterosexuality/homosexuality.
18
Questioning: People who are exploring their gender identity (and or sexual
orientation).
Sexual Orientation: One’s romantic and erotic attractions to other people. The
terms Gay, Lesbian, Heterosexual, Transsexual, and Bisexual or Polysexual are intended
to describe attractions to a particular sex/gender, while Queer or Pansexual is used by
some people to indicate attraction outside the binary norms of sex and gender.
Stealth: A choice made by some trans people to live full time as members of their
self-identified gender, to avoid revealing their past, and to avoid outing themselves as
trans. Trans persons often go stealth to avoid harassment and violence.
Third Sex: Persons not falling into usual biological descriptions of man or
woman, male or female.
Transsexual: A person whose sexual identity is entirely with the opposite sex.
Two Spirit: One who fulfills many mixed gender roles.
Transphobia: The aversion to or prejudice against transsexuality or transgender
people, such as the refusal to accept the individual’s expression of their gender identity.
Assumptions. The fundamental assumption of this research project is that all
sexual and gender minority individuals and their families deserve access to mental health
care and supportive services by trained and skilled practitioners. It is also assumed that
colleges and universities have an obligation and a responsibility to prepare graduate
students of social work to work directly with gender and sexual minorities. All persons
seeking supportive services from mental health practitioners, regardless of gender or
19
sexual identities deserve to have practitioners who are LGBTQ competent and prepared
to deal with the unique stressors regarding sexual and gender minorities.
Justification. The National Association of Social Workers (NASW) Code of
Ethics, under section 1.05, Cultural Competence and Social Diversity, states that (c)
Social workers should obtain education about and seek to understand the nature of social
diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual
orientation, age, marital status, political belief, religion or mental or physical disability.
This study is in alignment with this fundamental decree of social work practice.
Results from conducting a needs assessment of second year graduate students
enable colleges and universities to better understand the level of knowledge gained (or
not) by students through the social curriculum. This study demonstrates where the current
gaps and disparities are located in the program of graduate studies in social work and
reveal the general comfort level of social work students in regards to working in direct
practice with sexual and gender minorities.
Limitations. The limitations of the study center around the generalizability of
findings, which are limited due to the number of participants and non-probability
sampling. This study is limited to 88 second-year graduate students in the Masters of
Social Work program, California State University, Sacramento, California. In addition to
a small convenience sample, research participants represent a specific geographical
location, which also limits the generalizability of study findings.
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Summary
Chapter one discusses and defines the problem, gives information about the
background of the problem and then discusses the purpose and intent of the research
paper. The theoretical framework is then discussed, the definition of terms is listed and
finally the assumptions, justification and limitations of the study are summarized.
The second chapter of this study provides a literature review that addresses four
aspects of mental health services for the LGBTQ community. The first section speaks to
the fact that there has been a construction of heteronormativity in our society. Several of
the articles identify an historical perspective of how the construction of heteronormativity
affects the LGBTQ community. The second part of the literature review discusses the
possibility of creating a culturally competent space for LGBTQ clients. The third part of
the literature review demonstrates the gaps and disparities in social work graduate
education while the final section of the literature review brings into perspective direct
mental health best practice options for students.
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Chapter 2
LITERATURE REVIEW
Being queer is a simple way to identify as having an attraction outside the binary
norms of sex and gender. Nonetheless, the Lesbian, Gay, Bisexual, and Transgender
communities continue to face many challenges in today’s society, including being
marginalized by social institutions, places of employment, educational institutions, family
members, and friends. When suffering from society’s marginalization, the queer person
seeks out mental health support. Unfortunately, not all licensed practitioners are trained
in queer theory, and many lack essential understanding of transgender identity and queerpresenting issues. Pazos (1999) notes that often times many helping professionals
erroneously perceive gender difference as an indicator of homosexuality or as inherently
pathological. Clinicians treating this population will be presented with a wide range of
gender identities and expressions. It is essential that clinical social workers be flexible in
their approaches to treatment, to be respectful toward any gender choice or nonconformity, and to be non-judgmental in their approach to helping the client explore these
issues. Unless clinicians educate themselves with the latest practice guidelines regarding
working with queers, they may do more harm than good.
The following 20 journal articles included in this literature review support the
assertion that there is a lack of knowledge pertaining to sexual and gender minorities
amongst social workers. The literature review first addresses theory, and then examines
how society has historically constructed a binary gender norm and how sexuality is
22
constrained to fit a fundamentally hetero-normative model. Secondly, the review
discusses the possibility of creating cultural competency and an arena that is safe for the
LGBTQ client. The preparedness of social work students and social workers while
working in direct practice with LGBTQ persons is discussed in part three of the literature.
The final part of the literature reviews and explores the issues of working directly with
gay/lesbian and transgender adults and youth.
Theory and Social Constructs
Perhaps one of the leading arguments of the demise of social construct would be
evident in the article presented by Arlene Istar Lev (2005). In “Disordering Gender
Identity,” she explores the very nature and possible exacerbation of historical
marginalization of the LGBTQ community, in addition to the potential damage caused by
using psychiatric diagnoses to label sexual behaviors.
Currently, the Diagnostic and Statistical Manual of Mental Disorders (APA, 2000
[DSM]) defines the permission of classification of the psychiatric nosology in our
western world. The current edition of the DSM was revised in the year 2000. This edition
includes the current diagnosis for Gender Identity Disorder (GID) as the official
diagnosis for Transexualism and Transvetic Fetishism (TF). The diagnosis of GID
followed by a thorough psychosocial assessment and evaluation is essential in order to
receive a physician’s referral to begin hormone replacement therapy, which is the first
step in gender transition. Many transgender individuals begin with this process and then
later forego sexual reassignment surgery.
23
For years this has been the model of practice. That being said, it is easy to
understand how deviant behavior, which is behavior deemed to be not normal, needs a
DSM diagnosis. Somehow the perpetuation of what is deemed as not normal or as
deviant becomes a mental disorder, as if being born within a gender that one cannot live
as is a symptom of dysfunction. Kutchins & Kirk (as noted by in Lev 2005), state that the
severity of this diagnosis is as unreasonable as the 1800 mental disorder of drapetomania,
a mental illness among African slaves whose primary symptom was trying to escape
slavery.
These diagnoses can be viewed as simple peculiar historical oddities, but the fact
remains that the DSM has impacted laws, public policy, and the reinforcement of
marginalization. However, the DSM diagnosis for many seems like a small price to pay
for medical care and hormone replacement therapy. In fact, the new DSM, which is due
out this May, 2013 will revoke GID as a diagnosis for transsexualism. The impact of the
removal of GID will most likely eliminate all insurance coverage for medical treatments.
The double-edged sword of liberation from the DSM has now created a system whereby
only those who are wealthy enough to afford out-of-pocket medical expenses for sex
reassignment would be able to transition sex. The historical implications will remain for
years to come.
McPhail (2004) examines social workers continuing to practice in the oppressive
model of binary categorization of male/female and hetero/homosexuality. Missing from
the mainstream social work literature is the perspective of any postmodern/queer theorist,
the latest sex research, and the experience of transgender individuals. This article
24
explores the issue of old theories meeting new theories: the paradigm is shifting from
outdated binary norms because they can be problematic. Scholars’ critiques of old
theories demonstrate that using categories to classify people is extremely limiting and
harmful. The thought of being in or fitting into only one category can be restricting and
does not acknowledge the fluidity and movement of gender and sexuality. The bisexual
person fits into none of these norms and the intersex individual is also left out of the bigender norm. McPhail (2004) discusses how these new theories and perspectives are
contradictory to many social work models. There is much dialog focusing on the fact that
most people would rather not fit into one of two discrete categories, but would rather
appear on a continuum of movement and mutability. This thinking would directly affect
the type of therapy of choice by the practitioner: the recognition of multiple positions on
the continuum would not place a value on any one location or position or discuss the right
or wrong, gay or straight versions of the story. In this scenario, reparative therapy is
completely inappropriate.
The use of continuums of gender and sexuality is preferred to the bi-normative
model, placing the focus on teaching postmodern and queer theories along with the
epistemological continuum, and challenging problematic diagnoses for gender nonconforming youth and adults, such as “Transvetic Fetishism” and “Gender Identity
Disorder.” McPhail (2004) Lastly, the article urges practitioners to encourage clients’
own narrative rather than try to fit them into some category that is pre-constructed.
The basic presupposition of queer theory is to pose an argument against what is
viewed as normal within the constructs of our society. Queer theory attempts to
25
deconstruct the social and cultural practices that construct normality. Essentially, queer
theory attempts to clarify or demonstrate the social constructs which are perceived as
normal in our society, attempting to make the familiar strange (Oswald, Kuvalanka,
Blume, & Berkowitz, 2009). Oswald et al. (2009) continue to explore the values that are
rooted in these normal constructions. Queer theory critiques lesbian-gay (LG) theory as
being somewhat limited and linear, providing no room for bi-sexuality. Bi-sexuality in
LG theory is considered a path traveled while one is emerging as being gay. The notions
of homosexuals as being psychologically adjusted provided fuel for a movement away
from the concept of homosexuality as a mental disorder (Oswald et al., 2009). Social
constructionists immediately protested and criticized the limitations of this thought. The
timing and synthesis of the need for sexual freedom and expression gave way to queer
theory.
Queer theory is successful at recognizing, as Oswald et al. (2009) point out, that
the world is composed of restricted categories and labels that create power relations.
These categories include linguistic binaries of heterosexual/homosexual, which in turn
create the foundation for the normal vs. deviance model. “Deviance” is derived from
what is not the center. Queer theory challenges that which is the center. For
deconstruction purposes, queer theorists investigate the rewards and power gathered by
those individuals, communities, and institutions that benefit from the hetero norm.
Queer theory is notable in that it allows for the deconstruction of, or seeing
through a clearer lens, that which has been constructed by society. Oswald et al. (2009)
explore the issue of social practices that construct the “normality,” leading to the
26
questioning of the values embedded in such constructions. These authors argue that social
workers in both the macro and micro workplace need to understand the sexual and gender
binaries that have been constructed by society.
Crawly and Broad (as cited in Oswald et al., 2009) state that queer theory
conceptualizes the world as comprising falsely-bounded and constructed categories that
imply permanence and lack fluidity. The article continues to support the argument that
our society is based upon power and social control. Hetero-normativity is what society
views as the center. The difficulty in social work practice is to integrate knowledge and
challenge the ideals that heterosexuality is the norm and that anything other than that
would be seen as deviant. Oswald et al. (2009) challenge the social work profession to
question how the center was constructed and how social workers can clarify this for
clients in practice. Queer theory demonstrates to the practitioner and the client a sense of
strength, once the social construction of the binary is pointed out.
Oswald et al. (2009) essentially argue that hetero-normativity pushes one to
reject the model that fuses together gender ideology, family ideology, and sexual
ideology as one theory. Queer theorists push one to observe family, gender, and sexuality
as interdependent. By supporting the hetero norm, social workers fail by allowing clients
to risk rejection by society, family members, friends, and community.
Queer theory is essential knowledge to any one social worker practicing with the
LGBTQ community. It is, as Oswald et al. (2009) point out, a postmodern approach in
which identity is fluid and contextual. The closing arguments to this article include a
macro-level approach to create classifications that are more inclusive.
27
Proceeding to heterosexual men and the discussion of gender-variant males who
consider themselves heterosexual but acknowledge their queerness, Heasley (2005)
demonstrates to us several cases where a redefining of the “type” needs to be addressed.
This work is not specific to working with the LGBTQ community, but rather a more
macro-level interpretation of what is needed as a society. The queer masculinities of
straight men do not have a similar representation to that of queer men and lack in
legitimacy as a form of masculinity. Frequently, straight males perceived to be queer or
who actively disrupt both hetero-normativity and hegemonic masculinity are
problematized. Heasley (2005) is a professor at a university sociology department and
has a research emphasis on men and masculinity. He has at times been mistaken for a gay
man because of his lighter voice, the fact that he does not care about sports, and the fact
that he is a feminist. Friends tell him that they would simply assume that he was gay if
they did not know that he was married. Heasley’s article is brought forth through the
author’s own experience.
The suggestion of a typology represents a truer picture than what is available to
the straight-queer male, who is seen as disturbing both heterosexuality and hegemonic
masculinity, and also as a potential contribution to the expansion of the conceptualization
of straightness and of masculinity. The typology needs to be opened and re-defined, reevaluated, and explored as an attempt to move past the more ancient definitions that
constrain and control us. They suggest a queering of hetero-masculinity in a variety of
ways. However, there is yet a language or framework for considering the ways in which
straight men can disrupt the dominant paradigm via either the straight-masculine
28
construct or a language that gives legitimacy to the lived experience (Heasley, 2005).
Reasons to examine the possibilities of a new typology include, first and foremost, the
premise that if one does not fit into the normative of masculine heterosexuality, there is a
need to fix or repair both gender and sexuality. This is the reason for the use of this
article for this argument. Secondly, and of equal importance, is the fact that the typical
hetero-male is legitimate in society and acknowledged, while the non-traditional, queerstraight male exists in the realm of the unknown and the unacknowledged. The labeling
of a person actually reifies the dominant group. The “Non” makes us invisible, and at
times can lead to thoughts and accusations of being deviant. Where does the history, the
story, the reality exist for the Non? In order to overcome the Non, one must reinvent
one’s self, which is a very arduous task in today’s society. In support of a typology
regarding the masculinities of the queer male, the author emphasizes the fact that if we
define a name and space for the actual experience where one can know and define one’s
self, this will in turn help to legitimize their experience. The author supports the fluidity
of all of these categories as the new paradigm of sexuality and gender representation.
This paper is an attempt to change and challenge social attitudes on a more macro-level
of socially-constructed sexual minority.
In an attempt to draw on practice models that further scrutinize the fact that there
are disparities when examining theoretical analyses of Lesbian, Gay and Bisexual
oppression, Fish (2008), points out the status quo as heterosexuality and the obvious
oppression of that which is considered other. Solutions offered by Fish (2008) would be
29
to develop a theoretical foundation for heterosexism, of which an anti-oppressive practice
with the LGB community can be developed.
The literature demonstrates how sexuality is under-theorized in the field of social
work. As discussed by Logan’s work (as cited in Fish, 2008), social workers and
students need knowledge of sexuality oppression regarding discrimination and
disadvantages. There appears to be a theoretical framework for others who are oppressed
because of race, disability, age, and even gender, but there is no similar framework when
it comes to sexuality. Through examining the norm of heterosexism, Fish (2008) reveals
to us that sexuality oppression exists and defines three conceptual domains:
1. Heterosexism is a belief system that values heterosexuality as
inherently normal and superior to homosexuality (normalizing
heterosexuality).
2. Heterosexism is based on the assumption that everyone is, or should
be, heterosexual (compulsory heterosexuality).
3. Heterosexism intersects with other forms of oppression such as
sexism, racism, and disablism (intersecting oppression). (p. 186)
The article continues in a style intended to develop a theory to provide validation
for social work practice with this community. The theory attempts to deconstruct old
paradigms and beliefs that many students and practicing social workers continue to
participate in. As social workers, Fish (2008) points out, it is necessary to have a clear
understanding of the complexity of socialized heterosexuality.
30
Creating a Culturally-Competent Space for LGBTQ Clients
Cultural competency can have a positive impact upon a targeted population,
allowing educators, practitioners, and therapists to deliver a service that is more effective
and empowering of their clients. In an attempt to provide culturally competent
practitioners, this study conducted by Wilkerson, Rybicki, Barber & Smolenski (2011)
provided seven focus group discussions with health care providers. However, there are
always challenges when it comes to balancing the needs of minority communities,
providing culturally-competent services that are acceptable to the targeted community,
and dealing with providers who feel uncomfortable with the minority group.
The research conducted by Wilkerson, Rybicki, Barber & Smolenski (2011)
describes the difference between the Generic Cultural Competency vs. the Specific
Cultural Competency. Specific Cultural Competency refers to the skill set that is needed
while working with a specific population. As listed by the authors, the LGBT community
faces several barriers. Some of these barriers are attributed to internalized homophobia.
Internalized homophobia can lead to avoiding health and mental care, fear of disclosure,
and lying or withholding information about one’s sexual orientation. The unique case of
transgender clients’ difficulty when searching for a health care provider is due to the
significant lack of culturally-competent practitioners who could actually support the
gender transition.
More difficult to comprehend is that, even in 2013, practitioners fear that if they
carry an LGBT-supported patient base, they must worry most about discrimination from
other potential patients who are homophobic. In an effort to thwart such problems and to
31
cultivate systematic change, two groups got together to create what is called the
Healthcare Equality Index. The two groups credited for the creation of this index are the
Human Rights Campaign Foundation and the Gay and Lesbian Medical Association. The
index was created to help improve health care policy and to essentially serve as a
watchdog to ensure that health care facilities are updating their policies to be more LGBT
inclusive. Most large health and mental health care centers have a patient bill of rights
and/or non-discrimination policies. The Human Rights Campaign Foundation and the
Gay and Lesbian Medical Association worked together to gather data regarding same sex
visitation rights and special training for employee cultural competency, and also explored
the fact that most hospitals did not have intake forms that allowed patients to identify a
same sex domestic partner. These groups recommended that the establishment create a
best practice policy and guidelines by which health care centers can abide.
Seven focused group discussions were formed that included patients, social
workers, nurses, and physicians. Practitioners as well as patients included Lesbian, Gay,
Bisexual, Transgender, and unidentified. Focus groups discussed issues affecting both
providers and patients, such as coming out, relationship issues, family planning,
community resources, and gender identity. Discussions regarding paper work and the
online Electronic Medical Records, (EMR) record-keeping software, were also discussed.
At the conclusion of the focus group discussions, four distinct ideas emerged. The first
conclusion was that health care providers should understand how norms influence
behavior. The second conclusion for both medical and mental health care practices was
that there should be more LGBT-specific educational literature. The third conclusion was
32
that it would be beneficial to provide an LGBTQ directory. Lastly, a need for the creation
and requiring of LGBT-relevant EMR records was identified.
By addressing issues of cultural competence and cultural humility, practitioners
will be able to develop a better understanding of the minority stressors this community
experiences. As noted by Gezinski (2009), cultural competence is the end result of a
process requiring one’s attempt to recognize and understand another’s culture.
Recommended by the Council on Social Work Education [CSWE] (2008, p. 11), the
social work program and curriculum are expected to lead to an understanding of and
respect for diversity. The next section addresses the specific educational needs of social
workers regarding cultural competence training and culturally competent practice for
working effectively with sexual and gender minorities.
Social Work Education regarding the LGBTQ Population.
The majority of the existing literature regarding social work education is
primarily focused on the lack of information and education present in most social work
programs. Noted by Hylton’s work (as cited in Gezinski, 2009), colleges of social work
often fail to incorporate LGBTQ material in programs of study.
In the works produced by Fell, Mattiske & Riggs (2008), researchers opted to test
postgraduate clinical psychology students regarding their preparedness and abilities for
working with the LGBTQ population. The question of whether or not to include LGBTQ
materials in programs of study is an essential one when it comes to graduate students
feeling prepared for working with specific clientele. In light of this, an argument towards
33
more specific training of LGBTQ cultural competence and understanding of certain
populations is important to address.
The researchers developed essential points regarding direct practice with the
LGBTQ population. For example, when a practitioner is ill prepared for working with the
LGBTQ community there is a possibility that they may not be aware of the special needs
of the population. As noted by Fell et al. (2008), if a practitioner presumes that a client is
heterosexual, this can contribute to a failure to understand the client’s marginalization
and consequently keep the clients from receiving the optimal service.
Listed below are the four top reasons that a homosexual may experience
oppressive therapy:
1) They have experienced prejudice and discrimination their whole life, so their
biggest fear is discrimination from the practitioner;
2) The practitioner is unaware of social norms that may possibly contribute to
cultural differences that may impact service provisions;
3) The practitioner may have low confidence in their ability to provide services to
the LGB community in a culturally-sensitive manner; and
4) The practitioner may be prejudiced against same-sex attracted individuals and
that may potentially affect their practice.
The article continues to expand on qualifying disparities in training programs
regarding the LGBTQ population. Disparities in curriculum include lack of theory
training, cultural competency, and mental health protocols in direct practice.
34
The article articulates clearly-defined components that address guidelines for training
practitioners to attain cultural competence regarding psychotherapy with the LGBTQ
community.
To address the disparity of theory training, the authors educate the reader about
how privileges that are granted to those who are heterosexual are denied to same sexattracted couples through the basis of heteronormativity. To address the idea of cultural
humility training, the importance of exposure to culture, media, art, linguistics, history,
and other disciplines can engage the therapists in interest and interaction which allows for
the practitioner to be more comfortable in conversation with the client. As well, insight
allows them to deal with their own insecurity. Practitioners need to be able to identify
stereotypes and challenge them. Additionally, addressing direct mental health practice,
the therapist should engage in empathy, which allows for the development of the
necessary link in therapy: a sense of compassion and understanding. Lastly, on a macro
level, therapists should develop and identify personal strategies that help to challenge the
very existence of heteronormativity.
Van De Bergh & Crisp (2004) discuss the ways in which the process of
becoming a social worker requires commitment, dedication to understanding, and
constant obligation to further education. Current themes in education revolve around
creating culturally-competent clinicians. Ironically, this researcher is finding that, while
there are many ideas that revolve around cultural competency in working with the
LGBTQ persons, there is still no status quo or best practice imperative.
35
The movement towards cultural competency is rooted in ethnic and racial
minorities. Although in more recent years, it has expanded to include sexual and gender
minorities. The concept of the dual perspective, which includes the premise that the
clinician recognizes that there are social and cultural factors that affect clients paired with
familial, kin, and friendship relations, is introduced in the beginning of the article. Van
Den Bergh & Crisp (2004) continue to explore the importance of what the authors call
the cultural competent trilogy, which encompasses knowledge, attitude, and skills.
A simple concept developed by Lum’s work (as cited in Van Den Bergh & Crisp,
2004) demonstrates the importance of a basic framework of tools that he created. Those
four tools, listed below, can be used as a guide for students or therapists working with
LGBTQ clients.
1. Development of personal and professional awareness of ethnic person and events
that have been a part of the upbringing and education of the worker.
2. Acquisition of knowledge related to culturally diverse practice.
3. Development of skills to work with multicultural clients.
4. Ongoing discovery of the new facts about multicultural clients through inductive
learning.
Again, we see that these guidelines pertain mostly to cultural minorities and lack in
sexual and gender minorities’ concerns. In fact, the article states that even though the
National Association For Social Work (NASW) has prepared a foundation for
Cultural Competence, there includes no mention to date of how social workers should
36
apply a cultural competence approach to persons who are gay/lesbian/bisexual and
transgendered.
In the late 1990’s, the American Psychological Association (APA) created a task
force to examine the literature regarding LGBTQ clients. The focus and intent was also to
establish Guidelines for Psychotherapy with Lesbian, Gay and Bisexual clients. The
(APA) came up with sixteen guidelines that recommended certain conduct for therapists
working with sexual and gender minorities. The guidelines discuss everything from key
terminology to the practitioner who is dealing with his/her own homophobic tendencies.
The guidelines provide incredible support for those wishing to work with the LGBTQ
population, but as is the issue with so many of these guidelines, there is a lack of follow
through and accountability.
The article concludes by stating that the majority of work regarding cultural
competence has been biased and focused predominantly on racial and ethnic minorities.
Regardless, even as guidelines, protocols, and recommendations have been suggested,
there continues to be a lack of protocol and permanence of the educational rules and
accountability in regards to sexual and gender minority training, education, and practice.
It is often noted in much of the literature that students should seek out community
education and workshops. It is worth noting, though, that no matter how many guidelines,
protocols, foundations, and practice approaches are developed, there is still a neglect in
follow through with regards to which guidelines practitioners use, who holds them
accountable, and which guidelines are taught in colleges and universities.
37
Despite ideas in America about how social work education training validates and
endorses diversity, according to Rabow (as cited in Logie & Bridge & Bridge, 2008),
there is a current trend of intolerance of diverse social groups. What this literature does
seem to demonstrate is that, in particular, there are biases and negative attitudes held by
social workers towards LGBTQ persons, as noted by Berkman & Zinberg (as cited in
Logie et al., 2008). In the article, “Evaluating the Phobias, Attitudes, and Cultural
Competence of Master of Social Work Students Toward the LGBT Populations,” he
describes how the negative attitude presented by social workers appears to reflect and
mirror the sexual prejudice that is so often found in American society. Many studies have
addressed and assessed that attitude of social work students toward lesbian and gay
populations, but, as the researchers demonstrate, there remains a void in MSW students’
attitudes and phobias toward bisexual and transgender persons. (Logie et al., 2008)
Presented in the beginning of this article is the notion of culture, which is used
because it implies the integrated pattern of continued human behavior. This includes
learned behavior, values, communications, customs, and beliefs of certain social groups.
The historical ramifications of the pathology of homosexuality and transgender
identity have been partly due to the fact that the Diagnostic Statistical Manual (DSM)
deemed homosexuality an illness up until 1973. The pathology regarding transgendered
persons is only now being addressed and changed in the new version of the DSM 5,
wherein Gender Identity Disorder (GID) will no longer be a diagnosis for transgendered
persons. The article’s premise is that this cultural continuity of the pathologization of the
LGBTQ population has hindered the services providers’ homophobic and trans phobic
38
ideas. LGBTQ clients are thwarted by the attitudes of practitioners they encounter and so
they seek fewer services, which in turn leads to more exacerbated issues of discrimination
and cultural barriers to service. The same reasons that LGBTQ persons neglect their
medical issues are the same reasons they avoid mental health services. Unequal treatment
and assessment in therapy, misunderstandings resulting in misdiagnosis, and
pathologizing and devaluing are all potential results of the lack of cultural competency
regarding LGBTQ concerns. This continuum of pathologizing care, coupled with
persistent lack of information and education, has resulted in a higher percentage of this
population being dissatisfied with mental health services.
The premise of the study presented by Logie et al. (2008), was to measure the
attitudes, cultural awareness, and phobias of graduate-level students at Midwestern
American University. The study measured these three issues with 173 students
participating. Among some of the not-so-surprising findings, the most significant to this
researcher—and this study—is the fact that social workers are often uninformed
regarding relevant issues or inadequately prepared for working with the LGBTQ persons.
Unfortunately, graduate students’ lack of knowledge and preparedness surrounding
LGBTQ issues and treatment needs may lead to misunderstandings in practice,
potentially resulting in misdiagnosis.
Cultural competence is the result of a course of action requiring one’s attempt to
recognize and understand another’s culture. The framework that exists for social work
education is lacking a cultural competence component that would help to prepare social
work students to work with LGBTQ clients. Yet, as seen in Garnet’s work (as cited in
39
Butler, 2009), it is estimated that 99% of therapists will see at least one sexual or gender
minority (SGM) client during their careers. The importance of Linda Gezinski’s article is
that there is a foundation and curriculum presented to help prepare social workers to work
with the LGBT community.
As noted by the author, the lack of inclusion of LGBTQ diversity education is
rooted in the basic conjecture that sexual and gender orientation consistently ranks as
being less important than race and ethnicity. But both the Council of Social Work
Education and the National Association for Social Workers are committed to diversity
education—and state so in the standards set forth—so it is difficult to imagine the gaps
and disparities of diversity education in our social work programs at universities.
What is missing the most from the curriculum, and would be a means to
generating students that are culturally competent, is the framework that would
unequivocally address the reduction of heterosexism, which systematically privileges
those who have a heterosexual identity while simultaneously oppressing those who have
Lesbian, Gay, or Bi sexual identities. The writer notes the level of homophobia in
bachelor’s degree-level students, as noted by Riaz & Saltburg’s work (as cited in
Gezinski, 2011), which found that 21.3 percent of BSSW students were non-accepting of
lesbians and gay men while 40.0 percent of BSSW students were found to be merely
tolerant of those identities. The advocacy for a holistic approach that would examine the
micro/macro and theoretical/practical inclusion of LGBTQ material in social work
curriculum would allow for changes in these numbers. Also necessary in the education
process would be the training that teaches social workers a certain respect for diversity
40
and a critical examination of their own values and beliefs, as well as knowledge of
cultures different than our own.
Curriculum should also include development of necessary terminology and the
availability of community resources, advocacy, social services, and networks that
specifically address the needs of the LGBTQ community. Gezinski (2011) advocates for
an education that emphasizes the power dynamics of institutionalized heterosexism.
Meanwhile, the stages of psychosocial development can be examined with Erickson’s
stages of development.
Incorporation of Professional Mental Health Services.
It is essential that social work students integrate what they have learned during the
process of their education. An essential portion of the literature review will discuss how
students would integrate practice into practicum.
Catherine Crisp (2006) discusses the continual implications of homophobia
amongst social workers in her article titled, “The Gay Affirmation Practice.” The
implications of homophobia for the client can lead to inferior treatment in the form of
possibly trying to change the topic while the client is discussing being Gay or Lesbian,
trying to minimize or exaggerate the importance of sexual orientation, or, lastly, trying to
devalue the client’s experience.
The importance of this study was to assess and reveal the relationship between
social worker’s attitudes and practice with lesbian and gay individuals. The attitudes of
social workers regarding this population are an essential component of direct mental
41
health practice. As revealed by Berkman and Zinberg (as cited in Crisp, 2006), it was
found that 11% of randomly selected practicing social workers who were members of
NASW, were found to be homophobic, based upon their response to the Hudson and
Ricketts’s Index of Homophobia. Homophobia may, unfortunately, lead to inferior
treatment. Crisp (2006) explains further that homophobia may also cause the practitioner
to change the topic when clients speak about Gay or Lesbian issues; devalue the client’s
feelings and experiences; deny the clients access to a broad range of experiences; inform
clients that they are not gay because they fail to meet some arbitrarily-defined criterion;
and lastly, at its extreme, homophobia can lead to the use of conversion and reparative
therapy.
Gay Affirmative Practice models provide guidelines for treating gay and lesbian
individuals. Besides applying Gay Affirmative Therapy (GAP) to mental health practice,
these guidelines can also be incorporated into case management, child welfare, substance
abuse, and private practice.
The Gay Affirmative Practice guidelines are fundamental and easy to follow:

The first guideline is the essential premise that gay and lesbian individuals
should be considered in the context of the many environments in which
they interact. These places include their place of employment, family
settings, and social settings. Affirmative practitioners pay attention to
these settings and environments where their clients disclose their
sexuality.
42

Strengths perspective is another essential component. Practitioners should
affirm strengths, such as self-determination. Self-determination allows
clients to see homophobic forces in their own lives and can provide
strength when a client discloses their sexual orientation to loved ones.

Cultural Competence training edifies the therapist by providing a unique
knowledge base and set of attitudes and beliefs regarding the LGBTQ
population. The third aspect of GAP is to never assume that the client is
heterosexual and to support the client in deciding how to “out.” The last
angle the researcher discusses is to always remain open to new ideas,
education, and cultural perspectives.
As an openly gay practitioner, Koeting (2004) assumed that he had acquired the
skills to deal with Transgender clients after working with Gay and Lesbian clients for
over twenty years. He realized quickly, however, after receiving a phone call from a
Transgender client interviewing him for potential work, that he was not fully equipped to
handle all of these issues. The client called to ask him some simple questions regarding
transgender health and sexual re-assignment surgery (SRS) and questioned whether or
not he had ever worked with the Standard of Care (SOC). The questions that the client
asked required a fundamental knowledge regarding transgender issues, but the clinician
noted he had never heard of and had little or no knowledge of any of the above-listed
issues. The practitioner did much research and studying before meeting with his client for
the first time, studying and learning about the treatment of Queers and the special case of
Transgender. Koeting (2004) also noted that the unique issues of pre-operative male-to-
43
female (MTF) Transgender clients are separate and distinct from those of Gay or Lesbian
clients. Additionally, he points out that each Transgender client is unique in his or her
experience and presentation of confidence towards the transition. Transgender clients
most often begin their MTF transition with the practice of crossdressing, eventually
moving to hormone therapy, according to the gender to which they wish to transition.
Another piece of information discussed is the importance of being clear and
paying attention to the possibilities of counter-transference. The writer did not conduct a
specific study; rather, the writings came from his experience working with two specific
female-to-male transgender clients. Through reading and questioning methods used in the
past, and his own personal knowledge that being queer was simply not pathological, he
was able to help his clients transition with knowledge and understanding and the ability
to treat them as empowered and resilient.
Direct practice with transgender youth, specifically female-to-male is challenging
but can also be very rewarding. In discussing specific adolescent transgender clients,
Pazos (1999) argues that more specific literature about working with adolescent
transgender clients is necessary. She argues that there is fair amount of literature
regarding adolescent gay and lesbian issues, but there is very little work discussing the
extreme challenges faced by transgender youth. She examines the fact that many
professionals treat gender dysphoria as homosexuality, and have gone so far as to
continue treatment as though they are dysfunctional.
44
As a practitioner, she looks more closely at the female-to-male experience. She
notes that many had a powerful awareness at a very young age that something was not
right and then experienced a sense of shock and terror when they realized that their
bodies were different than biological males. Tactics for survival in heteronormative
families and societies that lack in knowledge and acceptance of transgender youth,
included detaching emotionally from their body, developing eating disorders, and, on a
deeper level, self-mutilating by smashing or pounding their chests until bruises appeared
(Pazos, 1999). Growing older, they began to wear male clothes, binding their chests and
packing or stuffing their pants in order to feel more like their true self.
Current treatment methods regarding trans persons as stated in the DSM-IV-TR
describe transsexualism as gender difference or Gender Identity Disorder (GID), viewing
the client as pathological. Unfortunately, this has allowed many therapists to direct their
client toward “accepting” or coming to grips with the gender they were biologically born
with. Pazos (1999) offers up solutions to address the lack of knowledge about queer and
transgender teens. Since sexual minorities suffer continued marginalization and
prejudice, she suggests that it is imperative that social workers educate themselves about
transgender issues by using texts written by authors who are transgender. Pazos (1999)
also demonstrates that transgender education needs to be addressed in graduate school. If
social workers are working directly with transgender youth and their families, a psychoeducational approach is best. This article argues in favor of established guidelines and
urges scholars to create such guidelines for working with queer youth and families.
45
After 24 years of private practice spent working with children and their families
and keeping updated with the latest practices via reading queer literature, Mallon (1999)
points out that basic social work education demonstrates disparities regarding gender
norms and that there are no social supports or educational institutions for the gender
variant child. Gender variant children, if not supported in transition, will often respond
with anxiety, fear, depression, low self-worth, self-mutilation, and suicidal ideation.
Mallon’s (1999) paper discusses gender variant children from a holistic
standpoint, where it is understood that children and their environments are to be
understood as composing a dynamic transaction. Children begin to feel or sense gender
identity, of some sort, sometimes by the age of three and children who are gender variant
are quickly socialized amongst those with gender-bound roles. As discussed by Mallon
(1999), the DSM IV-TR suggests early treatment in order to prevent trans-sexuality.
However, the criteria of Gender Identity Disorder as listed in the DSM IV-TR is
incredibly broad and can even include playing with dolls as a sign. Often times, there is
more harm than success in the process, from the point of the practitioner. There is no way
any practitioner or family member can “correct” a child’s gender. Furthermore, gender
variant children can be at great risk if a supportive environment cannot be created for
them. Ultimately, it must be understood that there is no cure for transgenderism. All
children, no matter what their issue, need love and support. Mallon writes that gay and
lesbian youth have their own separate stories to tell and homosexual youth should not be
mistaken for transgender. Her work provides the foundational framework to enhance
private practice or system work, as well: treatments for depression should not include
46
enforcement of gender stereotypical behavior, allowing for client freedom of expression
and clothing choice or compromising with parents. Practitioners need to develop
resources, make themselves aware of safety issues, and make sure that if they have a
practice working with the LGBTQ youth, they also educate themselves on transgender
issues.
Butler (2009) discusses the latest advances in therapy with gender and sex
minorities. The approach is called sexual and gender minority therapy (SGMT). SGMT is
used in conjunction with existing therapy methods. This has been referred to as, as Butler
describes, “gay affirmative therapy” or “sexual affirmative therapy.” The method proves
to be a very empowering and reverential way of working with sexual and gender
minorities. Butler (2009) states, “that of concern is that the majority of systemic
therapists receive relatively little training on how to work with SGM clients” (p. 339).
Butler extends some ground rules for working with SGM clients, with his
guidelines suggesting the client as the expert. When therapy begins, Butler suggests that
the client be allowed to ask any questions they feel relevant. This might include
disclosing yourself, which must be done very methodically, and really only in private
practice. Therapists should continue to focus on the clients’ concerns and their agenda.
Butler also reminds us to connect our clients to the wider systems that exist, to explore
positive networks, alternative films, and books. In therapy, Butler considers the stages of
grief when it comes to the loss of the heterosexual child for the parents, and works to
educate parents on changing inner perceptions—for example, alerting them to the
47
possibilities that still exist (i.e., that they can still be grandparents). As is always the case,
SGM therapists will link parents and children with other allies and support groups.
Ken Cooper (2000) writes a very attention-grabbing journal article that discusses
social work practice specifically with transgendered youth and their families. The article
begins with a brief discourse of duality of sex and gender in our world and the extreme
difficulty that we have in understanding this issue, considering the dualistic nature of
gender and sexual identity. The term transgender is relatively new and, as Cooper (2000)
reveals, can include a wide variety of non-traditional, non-binary identifications: drag
queens, cross dressers, she males, he-shes, transvestites, gender-blenders, and intersex
infants, just to name a few. Cooper states that in order to explore these label options, the
client is required to turn inside and unravel complicated feelings about whom they are
and how they wish to be perceived.
In the article Competencies for Counseling with Transgender Clients, which was
published in 2009 by the Association for Lesbian, Gay, Bisexual, and Transgender Issues
in Counseling with Transgender Clients, the authors (Burns et al., 2009) suggest a
premise that would establish competencies for counseling with transgender clients. These
competencies are geared toward professionally trained counselors who work with
transgender individuals, families, groups, and communities.
The competencies, as listed by Burns et al. (2009), are based upon wellness,
resilience, and strengths-based approaches. The practitioners are unique in their
theoretical approaches, affirming the commonality that all persons have the potential to
live fully functioning and emotionally healthy lives. The authors integrate multiple
48
cultural, social justice, and feminist approaches. The competencies are split into seven
subsections.
The first sections are the Human Growth Section. There are 12 competencies
listed under these sections. These competencies cover areas such as Human Growth and
Development and cover a list of 12 ideals regarding transgender development, keeping in
mind the special and unique development phase of transgender and affirming safe, transpositive transgender mental and medical health practices. The second subsection is Social
and Cultural Foundations, including appropriate language, internalized prejudices, and
understanding the intersecting of identities of race, ethnicity, class, religion, age, and
experiences of trauma. Helping Relationships is the third subsection, and includes the
training of practitioners and the linking with groups and individuals for support.
Group work is described under the fourth subcategory, edifying us on the
awareness of confidentiality, and coordinating treatment with other professionals.
Orientation is the fifth subsection and points to the concerns regarding the gender bias in
the DSM, and the addition of Gender Identity Disorder that was inserted when
homosexuality was removed as a mental disorder. Looking at concerns such as career and
lifestyle choices allow us to explore career choices that facilitate both identity and job
satisfaction. Discussed as well is the importance of the role of the counselor to advocate
continually for micro and macro policy and change. The last two subsections, as listed by
the Association, are Appraisal and Research, both of which prove it necessary for a
practitioner to remain updated to the fluidity of the gender and sexual minority groups
with whom they are working.
49
The practitioner’s need for a development of the therapeutic self is an imperative
of direct mental health practice with LGBTQ clients. The concept of the therapeutic self
can play a major role in the development of a positive attitudinal approach, both for the
writer and the reader/listener. What you do, what you say, as well as what you think and
feel make you unique and that uniqueness is the key to deep caring. The depth of caring,
meanwhile, will impact on the ability to bring change for the client. To achieve positive
change, the writer and the reader/listener must be first invited and then motivated to look
inside and to examine personal assets and liabilities. To be therapeutic, you must be
yourself and recognize your personal strengths, as well as your weaknesses, being willing
to work with them, bringing them to their highest levels.
Developing the Therapeutic Self, an the article presented by Valory Mitchell
(2010), recommends developing the therapeutic self for those therapists who are working
with the LGBTQ community. The article is a direct platform from the supervising work
she performs with trainees. The importance of the therapeutic self allows for a kinder
understanding and a more in-depth platform for change in relation to these specific issues
that she lists:
a. The coming out process.
b. Homophobia/heterosexism.
c. Role and relationship ambiguity.
d. The establishment of families of choice.
The issues she sets forth are better understood by someone who can practice the
therapeutic self. These are critical developmental points for the LGBTQ client. As the
50
writer explains, the trainee has no reason to be ignorant about LGBTQ issues. The writer
further explores how there is a plethora of information and articles out there, and
discusses how, as a supervisor, she no longer focuses on information during supervision
but rather on the trainee’s actual cases, experiences, and attitudes and values.
The therapeutic self emerges clearly as a benefit to not only the trainee but the
client as well. The writer explains further that during the supervisor trainee process, the
therapeutic self is allowed to develop. By bringing mirroring into the process, the
supervisors bring a positive expectation to their meetings with the trainees, and possibly a
sense of delight about the experience they will undertake together. The trainees will
internalize the mirroring function into the therapeutic self in several ways. The first way
is that they will acquire a realistic sense of self-esteem as therapists. The second is for the
trainee to develop a foundation of self-acceptance where they feel safe to explore their
personal weaknesses and failures as well as their strengths, goals and ambitions. The role
of the supervisor is to recognize the big picture of the trainee and to see what went well in
a therapy session and what went wrong. This provides a certain comfort for the trainees,
similar to that of a child and caregiver. The trainees eventually develop a greater sense of
calmness and confidence. Lastly, the trainee and the supervisor develop and recognize
their commonality, eventually seeing themselves as members of the professional
community. As the writer points out, the trainers become better practitioners and the
clients will benefit.
The insight found in Mitchell’s article is perhaps beyond any of the other articles
that this researcher had chosen. The three basic functions that a trainee may use as a
51
therapist became the same training ground in supervision. Mirroring, idealizing, and
twinship are all performed in therapy and are enhanced with supervision. The writer
continues in the article to explore the therapeutic self in regards to specifically working
with the LGBTQ community. The specifics of comfort and attitude while working with
the LGBTQ population are reflected through the above processes in supervision. Without
the knowledge gained from an honest appraisal of the personal self, the therapeutic self
can be in jeopardy of being ineffective as a change agent. So, social work practitioners
have self-work to do to bring this depth to their clients.
The above literature illustrates that the cultural and social norms regarding the
LGBTQ community need to be represented as fluid and redefined to include more than
just bi-gender norms of thinking. The articles demonstrate that, as social workers, it is
imperative to re-examine and re-evaluate how queer theory and transgender issues are
addressed in practice. Social workers must remain committed to updated theory and
education and the latest essential literature regarding narratives of those rewriting their
own stories of sexuality and gender. Updated guidelines that define how to work with
Queer clients need to be taught, reparative work needs to cease, and discussion regarding
socially-constructed norms of male/female and hetero/homo need to be re-established.
Summary
A review of the literature indicates that there has been a construction by society
that regards heterosexuality and a bi-gender status as the norm. Understanding this
construction allows for practitioners to demonstrate to their clients that this construction
52
and its relevant barriers do exist. The literature also reveals that cultural sensitivity and
humility training are necessary for students enrolled in the MSW programs. Lastly, the
literature review demonstrates that the LGBTQ community suffers from minority stress
and that the best practice in the recent past has been to pathologize. Moving forward, the
need for strengths-based, gay-affirming, and gender-affirming practices need to be
synthesized in order for practitioners to gain skills and proper training to empower this
population.
Chapter 3 will discuss the methods of the study, the study design, sampling
procedures, data collection procedures, measurement instruments and data analysis and
the protection of the human subjects protocol.
53
Chapter 3
METHODS
Study Design
The exploratory research design was utilized for the project, Queering Up. As
stated by Yegidis, Weinbach & Myers (2012), exploratory designs are predicated on the
assumptions that one needs to know more about something before one can begin to
understand it or attempt to confront it by using intervention methods with high potential
for success. Exploratory designs recognize that more information is needed. The
advantage of exploratory design is that it allows the researcher an opportunity to learn
more from a targeted population. This allows the researcher to uncover special needs
within the special populations of clients. The rationale for this particular study was to
reveal the level of knowledge of MSW Students regarding the Lesbian, Gay, Bi-sexual,
Transgender and Questioning population prior to graduation. The second year MSW
graduate student will enter the work force in one year, many of them already employed. It
should be noted that in Garnet’s work (as cited in Butler, 2009) it is estimated that 99%
of therapists will see at least one sexual or gender minority (SGM) client during their
careers. That being said, it is imperative that second year MSW students be prepared,
educated, and feel comfortable supporting, counseling, and advocating for the LGBTQ
population. Education allows students to become informed of ways to better support and
serve the positive and continued development of the LGBTQ population and understand
best how to address the challenges faced by the LGBTQ population.
54
Sampling Procedures
A convenience sampling method was used in this particular study. All professors
teaching second year social work practice courses in the MSW program at California
State University Sacramento were contacted and asked if they were willing to have this
researcher give a quick presentation regarding the consent form and questionnaire. Five
out of the seven sections of social work practice professors agreed to allow this
researcher to recruit participants from their courses.
A total of 88 surveys were distributed in order to gather data and measure the
level of knowledge of a second year Graduate Social Work Student. The survey was
limited to current second-year social work graduate students at Sacramento State
University California. The benefits of the questionnaire were twofold. The first
component of the survey was to determine the knowledge level of MSWs pertaining to
the LGBTQ’S unique concerns, issues, and stressors during psychotherapy. This data was
to identify that those knowledge disparities and gaps do exist. Such gaps include the lack
of LGBTQ knowledge and theory presented in graduate school. The second level of
measurement sought to identify the students’ level of comfort while working with the
LGBTQ community. It is quite possible that some students may suffer from homophobia,
trans-phobia, and insecurity while working with this population. As addressed by
Berkman & Zinberg (1997), the problems that the LGBTQ community face while in
therapy are often attributed to the social worker’s unconscious bias and, more
importantly, stem from an educational and informational deficit concerning the unique
55
difficulties that homosexuals suffer in a predominately heterosexual society. It is essential
for social workers to demonstrate competence in working with all populations. Cultural
competence should be addressed and emphasized on all levels of social work. Cultural
competence is extremely imperative while working on a micro level with such a
marginalized population.
Data Collection Procedures
Yegidis, Weinbach & Meyer (2012) state that the research for exploratory issues
and the selection of research participants or cases for study is usually not a rigorous or
exacting procedure when exploratory research designs are used. The questionnaires
regarding this study were distributed through the Master of Social Work Graduate
second-year practice classes, SWRK 204(D) at Sacramento State University, Sacramento,
California. The data collection process took place during the second week of Spring
Semester 2013 in five 204D classes.
After the short lecture regarding instructions for the questionnaire and
explanation of informed consent this researcher proceeded to hand out the consent form
for The Protection Of Human Subjects Protocol. This researcher then left the classroom
to insure the anonymity of the respondents. This particular study was deemed to be of
Minimal Risk by the Human Subjects Review Committee in the Division of Social Work.
Students wishing to not participate in the study remained seated while those who chose to
participate filled out the consent and questionnaire. The completed questionnaires were
then sealed in the manila envelope by the last student participant and brought to the
56
Practice Professor’s Office. The researcher then retrieved the envelopes from the
professor.
The participants who volunteered to be part of the study were provided with three
referrals of agencies that educate, counsel, and advocate for the LGBTQ community. If
further information was sought or if individual issues had arisen, each participant had
contact information so they could call or email either of the counseling centers. The
researcher’s and thesis advisor’s email addresses and phone numbers were both listed in
case there were any questions regarding the survey.
In an effort to ensure confidentiality, this researcher directed the survey
participants to put the consent forms into one envelope and the survey questions in
another envelope. The professor then took the envelopes to their office where this
researcher gathered the envelopes after the class was dismissed.
Measurement Instruments
The instrument utilized for the purpose of this study was a survey questionnaire
developed by the researcher (see Appendix A). The questionnaire was developed to
assess the level of knowledge and comfort of the second year graduate student. The
questionnaire consisted of 28 open-ended questions and 20 vocabulary questions, for a
total of 48 questions. The open-ended questions were designed to discover whether
students had experienced clients that were questioning either their gender or sexuality. If
the student marked that they had worked with questioning clients, the questions
continued to explore whether the student felt prepared, whether they felt comfortable, and
57
lastly, were they willing to advocate and support those clients. This component of the
questionnaire measured the level of comprehension and understanding of the unique
needs of the LGBTQ community. The level of knowledge and understanding were
assessed through the Likert scale questions, open-ended questions, and the 20 vocabulary
questions at the end of the survey.
The second component of the survey addressed the comfort level of the second
year MSW student in working with the LGBTQ population. The level of comfort was
measured by both open-ended and Likert scale questions. The level of comfort
component is an important dimension in that it allows the researcher to understand the
possibility that level of comfort may correlate directly with level of exposure during the
graduate students education. There is concern that the level of exposure to cultural
diversity and LGBTQ issues has historically been inadequate at the graduate school level.
Data Analysis
Data was analyzed following the receipt of all data materials from 204D
professors. After data collection, SPSS for Windows was used to compile data and
conduct statistical analysis. Data analyses of the various aspects of the study are
illustrated in the tables found in Chapter 4. Content analysis was used to identify themes
and trends in accordance with the responses of the open-ended questions. Frequency
distributions were used to analyze the Likert scale questions. The Yes or No questions
also were analyzed with the use of content analysis and frequency analysis.
58
Protection of Human Subjects
The application for the Protection of Human Subjects was prepared and submitted
to the Division of Social Work Human Subjects Review Committee in the fall of 2012 for
review and approval. Approval was given at the Minimal Risk level on January 23, 2013.
Summary
Chapter 3 discussed the study design, sampling procedures, data collection
procedures, instruments and data analysis, and lastly, the protection of the human
subjects protocol. Chapter 4 will review the study findings and will also provide
interpretation for the specific findings.
59
Chapter 4
OUTCOMES
The purpose of this study was to assess the need for sensitivity training regarding
sexual and gender minorities for Social Work Graduate Students. An exploratory survey
was utilized for this research project. In an effort to assess the need for sensitivity
training, this researcher composed an exploratory survey that included 27 research
questions, 20 vocabulary questions, and two questions that allowed for comments. A total
of 88 surveys were distributed and completed.
The survey questions were developed by this researcher and were designed to
determine the current awareness, knowledge, educational training, and background the
social work students possessed regarding the needs of LGBTQ community. The survey
questions also addressed the level of preparedness and comfort the social workers had in
responding to LGBTQ who were questioning their gender and sexuality. Social work
students were also asked how receptive they would be to participating in sensitivity
training. Finally, students were asked whether they thought that more in-depth training
regarding specified target populations would be beneficial.
Each survey question will be addressed in Specific Findings, with results tables
displayed adjacent to the original survey questions as a visual means for the reader.
Overall Findings
A total of 88 respondents, all of whom were second-year graduate students
attending Sacramento State University Graduate School of Social Work, completed the
60
questionnaire. The purpose of this assessment was to explore the level of knowledge and
level of comfort while working in a clinical setting with LGBTQ population. Most
importantly, this researcher wished to explore whether MSW II students felt prepared to
work with the LGBTQ community upon completion of graduate school.
Specific Findings
This project was designed to assess graduate students’ needs regarding working
with the LGBTQ population. The following survey questions were designed to assist in
defining that need:
Table 1: Exposure to classes that taught sensitivity to LGBTQ populations
In the course of your social work education have
Frequency
you ever participated in any classes that taught
sensitivity regarding the issues and needs of the
Valid
Lesbian, Gay, Bisexual, and Transgender
Percent
Yes
70
79.5%
No
18
20.5%
Total
88
100.0%
population?
Of the 88 respondents, 79.5% responded Yes, they have participated in sensitivity training regarding the
needs and issues faced by the LGBTQ population. 20.5% of the respondents said they had not had
specific training regarding the needs and issues.
Table 2: Exposure to classes that taught sensitivity to LGBTQ populations during internship
Have you ever participated in any special training
Frequency
at your MSW I or II internship that taught
sensitivity regarding the issues and needs facing
Lesbian, Gay, Bisexual, and Transgender clients?
Valid
Percent
Yes
26
29.5%
No
62
70.5%
Total
88
100.0%
Of the 88 respondents, 29.5% stated that they had a sensitivity training during their internship while
70.5% of the respondents had no such training.
61
Table 3: Exposure to clients who have questioned their sexual orientation
Have you ever been told by a
Frequency
client that he/she was questioning
his/her sexual orientation?
Valid
Percent
Valid Percent
Yes
36
40.9%
40.9%
No
52
59.1%
59.1%
Total
88
100.0%
100.0%
A total of 40.9% of the 88 respondents have been told by a client that he/she was questioning his/her
sexual orientation. 59.1% of the 88 respondents have not had a client who was questioning their sexual
orientation.
Table 4: Preparedness to respond to clients who are questioning their sexual orientation
How well prepared do you
Frequency
feel to respond to a client's
Not at all
questioning his/her sexual
orientation?
Percent
Valid Percent
7
8.0%
8.0%
Slightly
12
13.6%
13.6%
Somewhat
45
51.1%
51.1%
Very Much
17
19.3%
19.3%
Extremely
7
8.0%
8.0%
88
100.0%
100.0%
Valid
Total
Table 5: Comfort with responding to clients who are questioning their sexual orientation
How comfortable would you
Frequency
feel if you were faced with
Not at all
responding to a client's
questioning of his/her sexual
orientation?
Percent
Valid Percent
2
2.3%
2.3%
Slightly
17
19.3%
19.3%
Somewhat
28
31.8%
31.8%
Very Much
26
29.5%
29.5%
Extremely
15
17.0%
17.0%
Total
88
100.0%
100.0%
Valid
Table 5 refers to the level of comfort when responding to a client questioning his/her sexual orientation.
2.3% did not feel comfortable at all, 19.3% stated that they were only slightly comfortable, 31.8% stated
that they felt only somewhat comfortable, 26% said that they felt very much comfortable, and only 17%
62
of student responders stated that they felt extremely comfortable.
Table 6: Exposure to clients who have questioned their gender presentation
Have you ever been told by a
Frequency
client that he/she was questioning
his/her own gender presentation?
Valid
Percent
Valid Percent
Yes
13
14.8%
14.8%
No
75
85.2%
85.2%
Total
88
100.0%
100.0%
Only 14.8% of students who responded have experienced a client questioning their gender presentation
and 85.2% have not had a client questioning their gender presentation.
Table 7: Preparedness to respond to clients who are questioning their gender presentation
How well prepared did
Frequency
Percent
Valid Percent
you feel to respond to
Not at all
2
2.3%
15.4%
your client's questioning
Slightly
2
2.3%
15.4%
Somewhat
5
5.7%
38.5%
Very Much
3
3.4%
23.1%
Extremely
1
1.1%
7.7%
Total
13
14.8%
100.0%
System
75
85.2%
88
100.0%
of his/her gender
presentation?
Valid
Missing
Total
Of the 13 Yes respondents to table 6, 15.4% felt that they were not at all prepared to respond to their
clients questioning of their gender. 15.4% felt that they were slightly prepared, 38.5% felt that they were
somewhat prepared, 23.1% felt that they were very much prepared, and only 7.7% stated that they were
extremely prepared.
Table 8: Comfort with responding to clients who are revealing their sexuality or choice of gender
How comfortable did you
Frequency
feel in responding to the
client revealing his/her
sexuality or choice of
Percent
Valid Percent
Not at all
1
1.1%
7.7%
Slightly
2
2.3%
15.4%
Valid
63
gender?
Missing
Somewhat
3
3.4%
23.1%
Very Much
4
4.5%
30.8%
Extremely
3
3.4%
23.1%
Total
13
14.8%
100.0%
System
75
85.2%
88
100.0%
Total
7.7% of respondents stated that they were not at all comfortable with their client questioning or revealing
his/her sexuality, 15.4% were slightly comfortable, 23.1% were somewhat comfortable, 30.8% were very
much comfortable, and 23.1% were extremely comfortable.
Table 9: Exposure to clients who are Lesbian, Gay, Bisexual, or Transgender
Have you ever been told
Frequency
by a client that he/she was
Lesbian, Gay, Bisexual, or
Valid
Transgender?
Percent
Valid Percent
Yes
57
64.8%
64.8%
No
31
35.2%
35.2%
Total
88
100.0%
100.0%
A total of 64.4% of respondents stated that a client has told them that he/she was Lesbian, Gay, Bisexual,
or Transgender while 35.2% of respondents have not been told by a client that they were Lesbian, Gay,
Bisexual, or Transgender.
Table 10: Preparedness to respond to clients who reveal their sexuality or choice of gender
How well prepared did
Frequency
Percent
Valid Percent
you feel to respond to the
Not at all
3
3.4%
5.4%
client revealing his/her
Slightly
2
2.3%
3.6%
Somewhat
14
15.9%
25.0%
Very Much
20
22.7%
35.7%
Extremely
17
19.3%
30.4%
Total
56
63.6%
100.0%
System
32
36.4%
88
100.0%
sexuality or choice of
gender?
Valid
Missing
Total
64
A total of 56 out of 88 students responded yes to the question. Out of 56 responders, 5.4% of respondents
were not at all comfortable with their client revealing their sexuality or choice of gender, 3.6% of
respondents felt slightly comfortable, 25.0% felt somewhat comfortable, 35.7% felt very much
comfortable, and 30.4% felt extremely comfortable.
Table 11: Comfort in responding to clients who reveal their sexuality or choice of gender
How comfortable did you
Frequency
Percent
Valid Percent
feel in responding to the
Not at all
3
3.4%
5.3%
client revealing his/her
Slightly
2
2.3%
3.5%
Somewhat
5
5.7%
8.8%
Very much
28
31.8%
49.1%
Extremely
19
21.6%
33.3%
Total
57
64.8%
100.0%
System
31
35.2%
88
100.0%
sexuality or choice of
gender?
Valid
Missing
Total
A total of 57 students responded to the level of comfort question. 5.3% of students stated that they were
not at all comfortable, 3.5% were slightly comfortable, 8.8% were somewhat comfortable, 49.1% were
very much comfortable, and 33.3% were extremely comfortable.
Table 12: Confidence in knowledge of issues and needs of LGBTQ clients
Do you feel that you have the
Frequency
necessary knowledge of the
issues and needs of a Gay,
Valid
Lesbian, Bi-sexual or
Transgender client?
Missing
Total
Percent
Valid Percent
Yes
30
34.1%
34.5%
No
57
64.8%
65.5%
Total
87
98.9%
100.0%
1
1.1%
88
100.0%
System
Of the 87 students that responded, 34.5% of students stated that they do have the necessary knowledge of
issues regarding the needs of the LGBTQ client. 65.5% stated that they lack knowledge regarding the
LGBTQ population.
65
Table 13: Preparedness to assist clients with issues regarding sexuality and gender
Do you feel you are
Frequency
Percent
Valid Percent
prepared to assist a client
Not at all
12
13.6%
13.6%
with issues regarding
Slightly
24
27.3%
27.3%
Somewhat
35
39.8%
39.8%
Very Much
11
12.5%
12.5%
Extremely
6
6.8%
6.8%
88
100.0%
100.0%
sexuality and gender
identity?
Valid
Total
A total of 88 responded to this question. 13.6% of the respondents felt that they were not at all prepared
to assist a client regarding issues pertaining to sexual and gender identity. 27.3% stated that they were
slightly prepared, 39.8% felt that they were somewhat prepared, 12.5% felt as though they were very
much prepared, and only 6.8% marked that they felt extremely prepared.
Table 14: Exposure during 204A/B coursework to course content about the needs and issues
of the LGBTQ community
During the course of your 204A/B
Frequency
(practice) coursework at
Sacramento State, have you ever
Valid
been exposed to course content
Percent
Valid Percent
Yes
42
47.7%
47.7%
No
46
52.3%
52.3%
Total
88
100.0%
100.0%
about the needs and issues of the
LGBTQ community?
A total of 47.7% of the 88 graduate students at Sacramento State stated that they had been exposed to
course content regarding needs and issues of the LGBTQ community, while 52.3% stated that they had
not been exposed to this course content in their first year practice class.
Table 15: Exposure during 204C/D coursework to course content about the needs and issues
of the LGBTQ community
During the course of your 204C/D
(practice) coursework at
Sacramento State, have you ever
been exposed to course content
Valid
Frequency
Percent
Valid Percent
Yes
56
63.6%
63.6%
No
32
36.4%
36.4%
Total
88
100.0%
100.0%
66
about the needs and issues of the
LGBTQ community?
A total of 88 students responded to this question. 63.6% marked that they had been exposed to course
content regarding the needs and issues of the LGBTQ community, while 36.4% stated that they had not
been exposed.
Table 16: Satisfaction in graduate social work courses with the addressing of topics related to
issues and needs of LGBTQ community
How well do you think the
Frequency
topics related to the issues
Not at all
and needs were addressed in
your graduate social work
courses?
Percent
Valid Percent
5
5.7%
5.7%
Slightly
32
36.4%
36.4%
Somewhat
38
43.2%
43.2%
Very much
7
8.0%
8.0%
Extremely
6
6.8%
6.8%
88
100.0%
100.0%
Valid
Total
88 students responded to question 16. 5.7% of respondents stated that topics related to issues and needs
were not at all addressed in graduate course work, 36.4% stated that they were slightly addressed, 43.2%
said that they were somewhat addressed, 8.0% stated that they were very much addressed, and just 6.8%
noted that they were extremely addressed.
Table 17: Opinion on need for strengthening of LGBTQ issues and needs educational content in
MSW program
Do you think that the educational
Frequency
content in your MSW program of
study regarding the issues and
needs of Lesbian, Gay, Bisexual,
Valid
Percent
Valid Percent
Yes
84
95.5%
95.5%
No
4
4.5%
4.5%
88
100.0%
100.0%
Total
and Transgender clients needs to
be strengthened?
A total of 88 students responded and the majority, 95.5%, of students stated that the MSW program of
study regarding LGBTQ clients needs to be strengthened. 4.5% of students who responded stated that it
did not need to be strengthened.
67
Table 18: Receptivity to participating in training that taught sensitivity to issues and needs of
LGBTQ clients
Would you be receptive towards
Frequency
participating in training that
taught sensitivity regarding the
Valid
issues and needs of Lesbian, Gay,
Percent
Valid Percent
Yes
84
95.5%
95.5%
No
4
4.5%
4.5%
88
100.0%
100.0%
Total
Bisexual, and Transgender
clients?
A total 95.5% of respondents stated that they would be receptive towards participating in training that
taught sensitivity regarding the issues and needs of lesbian, gay, bisexual and transgender clients. A mere
4.5% stated that they were not interested in training.
Table 19: Perception of need for more information about the needs of LGBTQ clients
Do you feel that you need more
Frequency
information about the needs of
Lesbian, Gay, Bisexual, and
Valid
Transgender clients?
Percent
Valid Percent
Yes
79
89.8%
89.8%
No
9
10.2%
10.2%
88
100.0%
100.0%
Total
A total of 89.8% of students feel that they need more information about the need of gay, lesbian, bisexual and transgender clients, while 10.2% stated that they do not need more information.
Table 20: Willingness to work with clients who are Lesbian, Gay, Bisexual, or Transgender
How would you rate your
Frequency
Percent
Valid Percent
willingness to work with clients
Slightly
4
4.5%
4.5%
who are Lesbian, Gay, Bisexual
Somewhat
6
6.8%
6.8%
Very Much
23
26.1%
26.1%
Extremely
55
62.5%
62.5%
Total
88
100.0%
100.0%
or Transgender?
Valid
68
Of the 88 students that responded, 4.5% were slightly willing to work with the LGBTQ population, 6.8%
are somewhat willing to work, 26.1% are very much willing to work with LGBTQ clients, and 62.5% are
extremely willing to work with LGBTQ clients.
Table 21: Receptivity to supporting and advocating for LGBTQ clients
How would you rate your
Frequency
Percent
Valid Percent
receptivity to supporting and
Not at all
2
2.3%
2.3%
advocating for LGBTQ
Slightly
7
8.0%
8.0%
Somewhat
8
9.1%
9.1%
Very much
23
26.1%
26.1%
Extremely
48
54.5%
54.5%
Total
88
100.0%
100.0%
clients?
Valid
2.3% of student are receptive to supporting and advocating for LGBTQ clients, 8.0% are slightly
receptive, 9.1% are somewhat willing, 26.1% are very much receptive, and 54.5% are extremely
receptive.
Table 22: Preference of working with specific target population for second-year MSW students
As a second-year MSW student,
Frequency
have you decided what target
population you would prefer to
Valid
work with?
Percent
Valid Percent
Yes
65
73.9%
73.9%
No
23
26.1%
26.1%
Total
88
100.0%
100.0%
A total of 73.9% of second year graduate students have decided what target population that they would
prefer to work with, while 26.1% are unsure.
Table 23: Preference between specific training regarding their target population or writing thesis
If given the choice, would you
Frequency
prefer to take 9 units of study
pertaining to the specific
counseling theories, treatment
protocols and policy regarding
Valid
Percent
Valid Percent
Yes
75
85.2%
85.2%
No
13
14.8%
14.8%
Total
88
100.0%
100.0%
69
your target population, rather than
participate in the "culminating
experience" process of writing a
thesis.
A total of 85. 2% of students stated that they would prefer more specific training regarding their target
population rather than participate in thesis, while 14.8% answered No to this question.
Table 24: Preparedness to work with target population based on depth of study of
target population
If it were possible to study target
Frequency
Percent
Valid Percent
populations in more depth, do you
feel you would be more prepared
Yes
82
93.2%
93.2%
No
5
5.7%
5.7%
88
100.0%
100.0%
Valid
to work with that population?
Total
Of the 88 respondents, 93.2% of students stated that they would feel more prepared to work with a
specific population if they got to study it more in depth, while 5.7% stated that they would not feel more
prepared.
Table 25: Exposure to queer theory
What has been your
Frequency
exposure to queer theory?
Percent
Valid Percent
Not at all
22
25.0%
25.0%
Slightly
31
35.2%
35.2%
Somewhat
20
22.7%
22.7%
Very much
13
14.8%
14.8%
Extremely
2
2.3%
2.3%
88
100.0%
100.0%
Valid
Total
Of the 88 respondents, 25.0% of students had been exposed to queer theory, 35.2% stated that they were
slightly exposed, 22.7% were somewhat exposed, 14.8% were very much exposed, and 2.3% were
extremely exposed.
70
Table 26: Exposure to works of Judith Butler
Have you ever been exposed to
Frequency
the works of Judith Butler?
Valid
Percent
Valid Percent
Yes
30
34.1%
34.1%
No
58
65.9%
65.9%
Total
88
100.0%
100.0%
Of 88 respondents, 34.1% of students had been exposed to the works of Judith Butler and 65.9% of
students had not been exposed.
Table 27: Exposure to works of Adrienne Rich
Have you ever been exposed to
Frequency
the works of Adrienne Rich?
Valid
Percent
Valid Percent
Yes
10
11.4%
11.4%
No
78
88.6%
88.6%
Total
88
100.0%
100.0%
A total of 88 respondents revealed that 11.4% had been exposed to the work of Adrienne Rich and
88.6% had not been exposed.
Table 28: Exposure to works of Michel Foucault
Have you ever been exposed to
Frequency
the works of Michel Foucault?
Valid
Percent
Valid Percent
Yes
44
50.0%
50.0%
No
44
50.0%
50.0%
Total
88
100.0%
100.0%
50% of the students had been exposed to Michel Foucault.
The next 20 tables pertain to the vocabulary section of the survey questionnaire.
Table 29: Understanding of BDSM
BDSM
Frequency
Valid
Yes
28
Percent
31.8%
71
No
60
68.2%
Total
88
100.0%
A total of 31.8% of the 88 respondents stated that they know what BDSM stands for, while 68.2% said
they did not know what the acronym stands for.
Table 30: Understanding of queer
Queer
Frequency
Yes
Valid No
Total
Percent
78
88.6%
10
11.4%
88
100.0%
Of the 88 students that responded, 88.6% of respondents knew the meaning of queer while 11.4% did not
know the meaning.
Table 31: Understanding of MTF
MTF
Frequency
Valid
Percent
Yes
33
37.5%
No
55
62.5%
Total
88
100.0%
Of the 88 respondents, 37.5% of students selected Yes to understanding MTF and 62.5% selected No.
Table 32: Understanding of Poly
Poly
Frequency
Valid
Percent
Yes
33
37.5%
No
55
62.5%
Total
88
100.0%
Of the 88 student respondents, 37.5% of students questioned answered that they knew what Poly meant,
while 62.5% did not know.
72
Table 33: Understanding of pegging
Pegging
Frequency
Valid
Percent
Yes
6
6.8%
No
82
93.2%
Total
88
100.0%
Only 6.8% of students answered that they knew what pegging was, while 93.2% marked that they did
not.
Table 34: Understanding of cis gender
Cis gender
Frequency
Valid
Percent
Yes
32
36.4%
No
56
63.6%
Total
88
100.0%
Fewer than half of the 88 respondents, 36.4%, stated that they knew the meaning of cis gender while
63.6% did not what it meant.
Table 35: Understanding of gender queer
Gender Queer
Frequency
Valid
Percent
Yes
55
62.5%
No
33
37.5%
Total
88
100.0%
Only 62.5% of the 88 respondents stated that they knew the definition of gender queer, while 37.5%
stated that they did not know the definition.
Table 36: Understanding of cross dresser
Cross Dresser
Frequency
Percent
Yes
87
98.9%
No
1
1.1%
Valid
73
Total
88
100.0%
Of the 88 persons surveyed, only 1.1% did not know what a cross dresser was. 98.9% of students did
know what a cross dresser was.
Table 37: Understanding of transsexual
Transsexual
Frequency
Valid
Percent
Yes
84
95.5%
No
4
4.5%
88
100.0%
Total
As many as 95.5% of the 88 respondents knew what a transsexual is.
Table 38: Understanding of two spirit
Two Spirit
Frequency
Valid
Percent
Yes
42
47.7%
No
46
52.3%
Total
88
100.0%
More than half, or 52.3%, of the 88 students did not know the meaning of two spirit.
Table 39: Understanding of bi gender
Bi Gender
Frequency
Valid
Percent
Yes
51
58.0
No
37
42.0
Total
88
100.0
A total of 58% of the 88 student respondents knew the meaning of bi gender, while 42% did not know.
74
Table 40: Understanding of asexual
Asexual
Frequency
Valid
Percent
Yes
67
76.1%
No
21
23.9%
Total
88
100.0%
A total of 76.1% of the 88 respondents said Yes to knowing the definition of the word Asexual, while
23.9% stated that they did not know the definition.
Table 41: Understanding of FTM
FTM (Female-to-Male)
Frequency
Valid
Percent
Yes
35
39.8%
No
53
60.2%
Total
88
100.0%
39.8% of students knew what FTM means, while 60.2% did not know.
Table 42: Understanding of gender blenders
Gender Blenders
Frequency
Valid
Percent
Yes
36
40.9%
No
52
59.1%
Total
88
100.0%
As many as 40.9% of the 88 respondents selected Yes to knowing what gender blenders means, while
59.1% of students selected No, they did not know the definition of gender blenders.
Table 43: Understanding of third sex
Third Sex
Frequency
Valid
Percent
Yes
31
35.2%
No
57
64.8%
Total
88
100.0%
75
A total of 64.8% of 88 respondents stated that they knew what third sex means, while 64.8% did not
know.
Table 44: Understanding of pansexual
Pansexual
Frequency
Valid
Percent
Yes
21
23.9%
No
67
76.1%
Total
88
100.0%
Of the 88 respondents, 76.1% did not know understand the term pansexual, while 23.9% did know.
Table 45: Understanding of FFS
FFS (Female Facial Surgery)
Frequency
Valid
Percent
Yes
1
1.1
No
87
98.9
Total
88
100.0
Of the 88 respondents, only one respondent, a total of 1.1% of sample, knew that FFS stood for Female
Facial Surgery, while 98.9% of students did not know what FFS stood for.
Table 46: Understanding of stealth
Stealth
Frequency
Valid
Percent
Yes
9
10.2%
No
79
89.8%
Total
88
100.0%
Of the 88 respondents, 10.2% of students knew the definition of stealth and 89.9% of student responders
did not know what the meaning of stealth was.
Table 47: Understanding of HRT
HRT (Hormone Replacement Therapy)
Frequency
Valid
Yes
5
Percent
5.7%
76
No
83
94.3%
Total
88
100.0%
Only 5.7% of respondents knew what HRT (Hormone Replacement Therapy) meant while 94.3% of
students did not know.
Table 48: Understanding of SRS
SRS
Frequency
Valid
Percent
Yes
5
5.7
No
83
94.3
Total
88
100.0
As with HRT, SRS (sexual reassignment surgery) stumped the majority of the second year social work
graduate population, with 94.3% not knowing what it meant. A mere 5.7% of student respondents knew
what SRS stands for.
Summary
Chapter 4 displayed and discussed the results of the questionnaire found in
Appendix A. Chapter 5 will conclude, summarize and make recommendations regarding
the results of the research.
77
Chapter 5
CONCLUSION, SUMMARY, AND RECOMMENDATIONS
Summary of Study
The LGBTQ community is potentially at risk because members of sexual and
gender minorities continue to face many challenges in today’s environment. Minority
stress, concerns regarding coming out, gender identity, transitioning, and family and
work environment are all reasons that members of the LGBTQ community seek therapy.
Graduate-level social work education has placed an importance on cultural humility
especially when it comes to racial and ethnic minorities. What is currently lacking in the
curriculum is sensitivity training regarding sexual and gender minorities. Without this
valuable sensitivity training, the newly graduated social worker often feels unprepared to
explore sensitive issues with their LGBTQ clients. This study surveyed 88 graduate
students in second-year social work practice courses at Sacramento State University. The
findings support the study's notion that gaps and disparities continue to exist in the social
work curriculum.
The exploratory research design was utilized for the project, Queering Up. As
stated by Yegidis, Weinbach & Myers (2012), exploratory designs are predicated on the
assumptions that one needs to know more about something before one can begin to
understand it or attempt to confront it using intervention methods that have a high
potential for success. The advantage of exploratory design is that it allows the researcher
an opportunity to learn more from a targeted population. This allows the researcher to
78
uncover special needs within special populations of clients. The rationale for this study
was to reveal the level of knowledge of MSW Students have regarding the Lesbian, Gay,
Bi-sexual, Transgender, and Questioning population prior to graduation. The second-year
MSW graduate student will enter the work force in one year, many of them already
employed. It should be noted that in Garnet’s work (as cited in Butler, 2009) it is
estimated that 99% of therapists will see at least one sexual or gender minority (SGM)
client during their careers. That being said, it is imperative that second-year MSW
students feel prepared, educated, and comfortable supporting, counseling, and advocating
for the LGBTQ population. Education allows students to become informed of ways to
better support and serve the positive and continued development of the LGBTQ
population and to also understand the best ways to address the particular challenges faced
by members of that population.
The instrument utilized for the purpose of this study was a survey questionnaire
developed by the researcher (see Appendix A). The questionnaire was developed to
assess the level of knowledge and comfort of the second-year graduate student. The
questionnaire consisted of 28 open-ended questions and 20 vocabulary questions, for a
total of 48 questions. The open-ended questions were designed to discover whether
students had experienced clients that were questioning either their gender or sexuality. If
the student marked that they had worked with questioning clients, the questions
continued to explore whether the student felt prepared and comfortable and, lastly,
addressed their willingness to advocate and support those clients. The level of knowledge
and understanding component of the questionnaire measured the level of comprehension
79
and understanding of the unique needs of the LGBTQ community. This component was
also assessed through Likert scale questions, open-ended questions, and 20 vocabulary
questions at the end of the survey.
Implications for Social Work
The findings of this research have the potential to inform social work practice on
the micro and macro levels. Students who participted in the survey repeatedly identified
gaps and disparities in social work education regarding sexual and gender minorities. The
implications of this research and these findings will have a direct effect on social work
students who enter the workforce. Social workers ideas and recommendations affect
policy, theory, mental health practice, and support and advocacy for the LGBTQ
population. Gaps in knowledge will only serve to continue the status quo and reinforce
the predudices and oppression already faced by this population.
Research findings from this study revealed that students believe there are gaps
and disparities regarding social work education as it pertains to the LGBTQ population.
Most respondents reported a willingness to participate in further sensitivity training
regarding the LGBTQ population. Table 18 addressed the notion of receptivity towards
participating in training that taught sensitivity regarding the issues and needs of Lesbian,
Gay, Bisexual, and Transgender clients. Of the 88 students who responded, a total of
95.5% noted that they were willing to participate in sensitivity training. Table 19 asked
students whether or not they felt they needed more information about the needs of
80
Lesbian, Gay, Bisexual, and Transgender clients, and a total of 89.8% students surveyed
responded affirmatively that they did feel they needed more information.
Concerning the comprehensive scale of social work on the macro level, there
were several emerging ideas pertaining to the topic. Emerging from the literature review
were the concepts of heteronormativity as a social construction and the bi gender
container that is created and maintained as the status quo in society, with any breach from
the status quo being seen as a deviation. Also emerging from the literature is the idea that
gender and sexuality are constucted by society through language, culture, and social
paradigms, which are constantly in flux. Queer theory attempts to deconstruct the gender
and sexuality constructs as they currently exist in our society. Of the 88 students who
particpated in the survey, 25.0% of respondents reported no exposure to queer theory
during the course of their social work education and only 14.8% of students responded
that they had “very much exposure.”
Social workers who have a better understanding of queer theory can advocate for
better policy and laws that concern the LGBTQ population. Informed social workers can
also assist in the construction and education of developing theoretical frameworks rooted
in social construction. Queer theory and ecological systems perspective can support the
use of the broad lens that can allow students to better understand the dynamics of
opression.
The implications of this research concerning the micro level of social work with
the LGBTQ population include the fact that the majority of social work students enrolled
in the graduate program at Sacramento State demonstrated that they would like more
81
training regarding this population. Table 16 of the survey asked the question, “how well
do you think the topics related to the issues and needs were addressed in your graduate
social work courses?” Of the 88 respondents, 36.4% of students demonstrated that they
were “slightly prepared,” while only 6.8% noted that they were “extremely prepared.”
Table 9 illustrates that 64.8% of students had been told by a client that he/she was a
Lesbian, Gay, Bisexual, or Transgender person. Of those 64.8% respondents, only 22.7%
felt “very much prepared” to respond to a client revealing his/her sexuality or choice of
gender. Table 12 represented the findings from question 12, “do students feel that they
have the necessary knowledge of the issues and needs of lesbian, gay, bisexual and
transgender clients?” 64.8% of students respondents revealed that they did not have the
necessary knowledge of the issues and needs of LGBTQ clients.
When it comes to the distinctive needs of the transgender clients, the gaps and
disparties become even greater. Table 6 asked students whether or not they had ever
experienced a client who was questioning their gender presentation. Of the 88
particpants, 13 responded that they had indeed experienced a client who was questioning
their gender. Of the 13 Yes responders, 15.4% felt that they were not prepared to work
with the transgender client, 15.4% stated that they were slightly prepared to work with
this population, and only 7.7% of the respondents noted that they felt extremely
comfortable working with this population.
Some of the LGBTQ-specific vocabulary that was included in the survey
instrument is more specific to the transgender population. Respondents were asked to
indicate Yes, they knew the definition of a certain term or, No, they did know the term’s
82
meaning. Basic vocabulary and acronyms were asked of the respondents and the results
were startling in regard to the current knowledge base of the student respondents. Table
41 shows the results of answers regarding understanding the acronym FTM (Female to
Male), which is a term used to represent one who is born female but has transitioned to
male. 60.2% of respondents answered No, they did not know this acronym. Table 45
asked students if they knew the acronym FFS (Female Facial Surgery), which is an
acronym frequently used for transitioning transgender clients. Of the respondents, 98.9%
reported that they did not know what FFS meant. Table 46 asked if students knew the
term stealth. Of the 13 respondents, only 10.2% of respondents stated affirmatively that
they knew the meaning, while 89.9% of students indicated they did not know the
meaning of the term. The last substantial term that this researcher deemed significant is
the one shown in Table 47, HRT (Hormone Replacement Therapy), which is the first step
one takes to begin the process of transition. Of the 88 respondents, 94.3% of respondents
reported that they did not know the definition for HRT.
As revealed by the research, MSW students remained less knowledgeable when it
came to terms most often used amongst the LGBTQ community. The results of the
survey determined that MSW students at Sacramento State are in need of additional
training regarding the prerequisites of the LGBTQ population. Also necessary is training
that addresses the specific needs of gender-questioning clients. More in-depth education
would provide the micro- and macro-level social worker with the knowledge, skills, and
tools needed to better assist the LGBTQ client during both micro and macro levels of
social work.
83
Recommendations
It is incumbent upon the professional (medical, mental health, social worker,
community advocate, and student) to be knowledgeable about LGBTQ issues. Master’s
of Social Work students play an extremely important role in the lives of the LGBTQ
community. Their soon-to-be influential role has the potential to affect the lives of the
LGBTQ population in either an empowering or a detrimental way. Social workers are
responsible for creating safe environments for clients, advocating for clients and, on a
macro level, creating policy that will affect the LGBTQ population positively.
As demonstrated by this research, basic sensitivity training is imperative for the
second-year graduate student. Table 19 of the questionnaire posed the question of
whether the students felt they needed more information about the needs of Lesbian, Gay,
Bisexual, and Transgender clients. A total of 89.8% respondents selected Yes. There was
a space left for comments and a total of 64 out of 88 respondents commented. Of the
78.9% that commented, the most common areas of interest were:
1. Information on barriers faced by the LGBTQ population in regards to
family, work, school, mental, and medical services.
2. Techniques, interventions and approaches that are useful when working with
LGBTQ population.
3. More information pertaining to the special needs of the Transgender client,
including legal matters such as name changing, the use of bathrooms, foster
youth, and medical protocol.
4. Legal issues for the Lesbian and Gay communities were also a concern.
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5. Lastly, more than 50% of the respondents wanted a specific class that taught
sensitivity training for this specific population.
When students were asked about the possibility of engaging in more specific
graduate school training that focused on counseling theories, treatment protocols, and
policies regarding a chosen population, for a total of nine units that would be taken in lieu
of writing a thesis, 85.2% of respondents stated that they would opt for more in-depth
training over writing a thesis (results shown in Table 23). In order for social workers to
fullfill their role and their obligation of ensuring the well being of their clients, this
researcher recommends mandatory sensitivity training for all graduate students.
Limitations
The limitations of the study focus mainly on the generalizability of findings,
which are limited due to the number of participants and non-probability sampling. This
study was limited to 88 second-year graduate students in the Masters of Social Work
program, Sacramento State University, Sacramento, California. In addition to a small
convenience sample, research participants represent a specific geographical location,
which also limits generalizability of study findings.
Suggestions for future study regarding the already-gathered data include the
possibility of bundling themes present in the questionnaire and discovering outliers and
disparities. Correlating the data that reflected level of training vs. level of comfort,
research could also compare the level of knowledge accessed about lesbians and gays in
comparison to transgender clients.
85
Program emphasis at the graduate-school level should consist of cultural
competency training that embraces ethnic and racial competencies alongside sexual and
gender minority competencies, celebrating queer theory for the deconstructivist values
and ideals raised in the literature, studies and framework. Another theory that is inclusive
of understanding is Butler’s work (as cited in Rudy, 202), which explains that gender
isn’t something one is born with; it is something that one is born into. Pertaining to
sexual minority issues, Julie Fish (2008) summarizes:
(i)
The family is a key site in which heterosexuality is normalized.
(ii)
The status of heterosexuality has depended on the vanishing of the LGB
existence: sexuality issues are not addressed in the academic and practice
curriculum.
(iii)
Heterosexism intersects with racism, sexism, and disabilism in process,
which includes othering, treating everybody the same, and invisibilization.
(p. 183)
Without an emphasis on queer theory in social work education, educators fail again and
again and continue to support the problematic lens of a constructivist or essentialist view,
creating catagories without questioning the catagories themselves.
Conclusions
For the purpose of this paper, the literature review revealed an incredible amount
of information and several emerging ideas that were relevant to this researcher’s topic.
The social construct of hetero-normative and bi-gender norms are created and
86
maintained as the status quo in society. Any breach from the status quo is seen as a
deviation. Deviation from heteronormativity becomes pathology and pathology becomes
oppression. “Opression is defined as inhuman or degrading treatment of individuals or
groups…Opression often involves disregarding the rights of an individual or group and is
thus a denial of citizenship. Thompson work (as cited in Fish 2008, p. 183).
This study has revealed some key issues that warrant immediate action pertaining
to the preparedness of graduate of social work students. It has also revealed that there is
clearly a need for more research to be done in order to learn about several of the topics
addressed in this study; These topics include queer theory, the establishment of
guidelines for social work education as well as social work practice. Another topic would
address how to better educate students to be more reflective of the existence of the other;
and to continue to engage in sensitivity training and creating allied communities that
empower the LGBTQ community.
87
APPENDICES
Appendix A. Questionnaire: Assessing the Diversity Competency Needs of MSW
II Graduate Students in Working with LGBTQ Persons
Appendix B. Consent to Participate in Research
88
Appendix A
Assessing the Diversity Competency Needs of MSW II Graduate Students in
Working with LGBTQ Persons
By completing this questionnaire, you are giving your consent for your participation in this
research project. This project has been deemed minimal risk by the Human Subjects Review
Committee in the Division of Social Work, CSU Sacramento. This means that there may be a
slight possibility that a participant could potentially experience discomfort when contemplating
responses to survey questions. If you do experience any distress regarding the questionnaire, or if
you would like to know more about working with LGBTQ persons, you may contact the
following agencies:
The Gender Health Center: 916-455-2391
The Sacramento Gay and Lesbian Center: 916-442-0185
The Pride Center at CSUS Campus: 916-278-8720
This researcher is working under the supervision of Dr. Chrys Barranti.
Assessing the Diversity Competency Needs of MSW II Graduate Students in Working with
LGBTQ Persons
Directions: Please circle the response to each question that best reflects your opinion.
1.
In the course of your social work education, have you ever participated in any classes
that taught sensitivity regarding the issues and needs of the lesbian, gay, bisexual and
transgender population?
Please Circle
A. Yes
B. No
2.
Have you ever participated in any special training at your (MSW l or ll, Internship)
that taught sensitivity regarding the issues and needs facing the lesbian, gay, bisexual
and transgender clients?
Please Circle
A. Yes
B. No
3.
Have you ever been told by a client that he/she was questioning his/her sexual
orientation?
Please Circle
A. Yes
B. No
89
a. How well prepared do you feel to respond to a client’s questioning of his/her
sexual orientation?
Please Circle.
0 Not at all
1 Slightly
2 Somewhat
3 Very much
4 Extremely
b. How comfortable would you feel if you were faced with responding to a client’s
questioning of his/her sexual orientation?
Please circle
0 Not at all
1 Slightly
2 Somewhat
3 Very much
4 Extremely
4.
Have you ever been told by a client that he/she was questioning his/her own gender
presentation?
A. Yes
B. No
If Yes:
a. How well prepared did you feel to respond to your client's questioning of
his/her gender presentation?
Please Circle.
0 Not at all
1 Slightly
2 Somewhat
3 Very much
4 Extremely
b. How comfortable did you feel in responding to the
client questioning of his/her gender presentation?
Please circle
0 Not at all
1 Slightly
2 Somewhat
3 Very much
4 Extremely
5. Have you ever been told by a client that he/she was lesbian,
gay, bisexual or transgender?
A. Yes B. No
If Yes:
a. How well prepared did you feel to respond to the client revealing his/her sexuality?
Please Circle.
0 Not at all
1 Slightly
90
2 Somewhat
3 Very much
4 Extremely
b. How comfortable did you feel in responding to the client revealing his/her
sexuality or choice of gender?
Please Circle.
0 Not at all
1 Slightly
2 Somewhat
3 Very much
4 Extremely
6.
Do you feel that you have the necessary knowledge of the issues
and needs of a gay, lesbian, bi-sexual or transgender client?
Please Circle
A. Yes
B. No
7.
Do you feel you are prepared to assist a client with issues
regarding sexuality and gender identity?
Please Circle
0 Not at all
1 Slightly
2 Somewhat
3 Very much
4 Extremely
8.
During the course of your 204 A/B (practice) coursework
at Sacramento State, have you ever been exposed to course
content about the needs and issues of the LGBTQ community?
Please circle
A. Yes B. No
9.
During the course of your 204 D/C (practice) coursework at Sacramento
State, have you ever been exposed to content about the needs and issues of
the LGBTQ community?
Please circle
A. Yes
B. No
10.
How well do you think the topics related to the issues and needs were
addressed in your graduate social work courses?
Please Circle
0 Not at all
1 Slightly
2 Somewhat
3 Very much
91
4 Extremely
11. Do you think the educational content in your MSW program of study
regarding the issues and needs of lesbian, gay, bisexual and transgender
clients needs to be strengthened?
Please Circle
A. Yes B. No
12. Do you feel that you need more information about the needs
of gay, lesbian, bisexual and transgender clients?
Please Circle
A. Yes B. No
If yes, what kind of information do you need?
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
__________________________________________
13.
Would you be receptive towards participating in training
that taught sensitivity regarding the issues and needs of lesbian, gay, bisexual and
transgender clients?
Please Circle
A. Yes B. No
14.
How would you rate your willingness to work with clients that
are lesbian, gay, bisexual or transgender?
Please Circle.
0 Not at all
1 Slightly
2 Somewhat
3 Very much
4 Extremely
15.
How would you rate your receptivity to supporting and
advocating for lesbian, gay and bisexual clients?
Please Circle.
0 Not at all
1 Slightly
2 Somewhat
3 Very much
4 Extremely
16. As a second year MSW student, have you decided what target population you would prefer to
work with?
Please Circle.
A. Yes B. No
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17. If given the choice, would you prefer to take 9 units of study pertaining to the specific
counseling theories, treatment protocols and policy regarding your target population, rather than
participate in the “culminating experience” process of writing a thesis?
Please Circle
A. Yea B. No
18. If it were possible to study target populations in more depth, do you feel you would be more
prepared to work with that population?
Please Circle
A. Yea B. No
19. What has been your exposure to queer theory?
Please Circle.
0 Not at all
1 Slightly
2 Somewhat
3 Very much
4 Extremely
20. Have you ever been exposed to the works of Judith Butler?
Please Circle
A. Yes B. No
21.Have you ever been exposed to the works of Adrienne Rich?
Please Circle
A. Yes B. No
22.Have you ever been exposed to the works of Michel Foucault?
Please Circle
A. Yes B. No
Vocabulary knowledge
Listed below are several terms that may arise while working with the LGBTQ Community.
PLEASE only circle Yes if you are absolutely confident of the definition or meaning of the term.
Circle No if you are unsure. Your honesty is greatly appreciated.
23. BDSM
A. Yes B. No
24. Queer
A. Yes B. No
25. Poly
93
A. Yes B. No
26. Pegging
A. Yes B. No
27. Cis Gender
A. Yes B. No
28. Gender Queer
A. Yes B. No
29. MTF?
A. Yes B. No
30. Cross dresser
A. Yes B. No
31. Transexual
A. Yes B. No
32.Two Spirit
A. Yes B. No
33. Bi gender
A. Yes B. No
34. Asexual
A. Yes B. No
35. FTM
A. Yes B. No
36. Gender blenders
A. Yes B. No
37. Third sex
A. Yes B. No
38. Pansexual
A. Yes B. No
39. FFS
A. Yes B. No
40. Stealth
A. Yes B. No
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41. HRT
A. Yes B. No
42. SRS
A. Yes B. No
Do you have any other thoughts regarding your LGBTQ diversity education and training in the
MSW program? Any ideas pertaining to this issue are greatly appreciated.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Thanks for your participation!
95
Appendix B
Consent to Participate in Research
I, __________________________________, have been asked to participate in a research project
being conducted by Janice Stanley, M.S.W. Student at CSU, Sacramento. Ms. Stanley is working
under the direction of her thesis advisor, Dr. Chrys Barranti.
Purpose of the Research
I understand that the purpose of this study is to provide an opportunity to measure the level of
understanding of the sensitive issues faced by the lesbian, gay, bisexual, transgender, and queer
(LGBTQ) community. The study will also measure the level of comfort for social workers while
working with the LGBTQ population.
Duration and Location:
I understand the questionnaire will take a total of approximately 15 minutes. I understand that I
am not mandated to participate in the questionnaire and have the option to not participate.
Research Procedures
It has been explained to me that the research will consist of a questionnaire. The questionnaire is
designed to measure a level of knowledge regarding terms and theories frequently referred to by
the LGBTQ population. It is my understanding that there are also questions that pertain to a level
of comfort referring to the practitioner when working amongst some of these very sensitive issues
regarding non-hetero normative sexuality and gender identity.
Risk
It has been explained to me that this project has been deemed to be a minimal risk research study
because the questions in the questionnaire maybe personal in nature as they explore issues related
to sexuality and gender. In addition, the questions also measure the comfort level of practitioners
working with the LGBTQ community. Therefore, while it is anticipated that I should experience
little to no discomfort in participating in this research project, there is a slight possibility that in
responding to some of the questions, I may experience some distress. Should I experience
distress or discomfort, I understand that I can contact any of that the following three agencies
listed below to address any questions, concerns or any distress that may arise as a result of my
participation in this study.
The Gender Health Center: 916-455-2391
The Sacramento Gay and Lesbian Center: 916-442-0185
The Pride Center at CSUS Campus: 916.278.8720
Benefits
I understand that the benefits from participating in this project include increasing my own
knowledge as well as insight regarding my personal comfort level in working with the LGBTQ
community. Results may contribute to the development of future curriculum that increases
knowledge and facilitates comfort in working with the LGBTQ population. Consequently, results
may help facilitate culturally competent practice with this population and access to informed
services.
96
Confidentiality I understand that there will be no names printed on the questionnaires. The
questionnaires will be destroyed when the research has been completed. When the study is
published, there will be no
identifying information that would be directly associated with any information obtained from me.
All data collected including this consent form and any information will be kept in a secure
location under lock and key, except when being used by Ms. Janice Stanley for analysis.
Compensation
I understand that there will be no compensation for participating in this research project.
Contact Information
I understand that if I have any questions about this research now or in the future, I may contact
Dr. Chrys Barranti, 916 278-7183 cbarranti@csus.edu.
Right to Withdraw:
I understand that I do not have to take part in this project, and my refusal to participate will
involve no penalty or loss of rights to which I am entitled. I may withdraw from the project at any
time without fear of losing any services or benefits to which I am entitled.
Signatures:
My signature below confirms that this entire consent form has been explained to me, and that I
completely understand my rights as a potential research participant. I have addressed all questions
and concerns to Ms. Janice Stanley, and I understand that I can also address any additional
questions immediately after the interview or in the future by contacting Dr. Chrys Barranti at 916278-7183, cbarranti@csus.edu. I voluntarily consent to participate in this project. I have been
informed that I will receive a copy of this consent form. My participation in this research is
entirely voluntary. I may decide to not participate in this research without any consequences. I
may also change my mind and stop participating in the research at any later time without any
consequences. My signature below indicates that I have read this page and the attached Research
Subject Bill of Rights, and that I understand the risks involved and agree to participate in the
research.
_________________________ _________
Signature of Participant
Date
___________________________ _______
Signature of Researcher
Date
97
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