Social Work Practice with the LGBTQ Community: The Intersection of

Social Work Practice with the LGBTQ Community: The Intersection of History, Health, Mental Health and Policy Factors Chapter 11: Affirming and Strengths-Based Models of Practice AUTHORS: TREVOR G. GATES, PHD, LCSW BRIAN L. KELLY, PHD, MSW, CADC CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 1

Introduction This presentation provides highlights from Chapter 11, regarding affirming and strengths-based practice. It provides an overview of: The strengths perspective in social work practice; Historical trends in affirmative practice; Complementary practice approaches Two case scenarios with questions for consideration; Pertinent national resources with web links; and Listing of all references cited CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 2

Defining Affirmative and Strengths-Based Practice Refers to the range of practice models that create a safe, supportive environment for individuals to express their sexual orientation and varied gender identities and expressions Grounded in the assumption that LGBTQ identities are normal and expected parts of the human experience Acknowledges and affirms individuals’ identities without assuming the individual is ‘struggling’ with their identity or that the core of the individual’s psychosocial issues is related to sexual orientation or gender identity and expression (Van Den Bergh & Crisp, 2004) Acknowledge LGBTQ identities as an important part of life that may or may not be directly impacting the client’s presenting issues and work to help the client integrate their LGBTQ identity with the rest of their lives (Lebolt, 1999; Malyon, 1982) CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 3

Other Historical Trends Identity development models useful for affirming practice: A commonly cited contribution to LGBTQ affirming and strengths-based practice is the Cass Model of Homosexuality Development Cass (1984) proposed a 6-stage model for identity development, including identity confusion, identity comparison, tolerance, acceptance, pride, and synthesis. Sexual liberation, HIV/AIDS and sex positive interventions Homophile Movement during the 1950s and 1960s, a movement that made significant strides in creating spaces for homosexuals and lesbians to connect and challenge, fight, march, and speak out against the discrimination and prejudice enacted on them by the dominant heterosexist and homophobic culture. D’Emilio (1998) proposes it was the Homophile Movement that provided the foundation for the Gay Liberation Movement that followed it in the late 1960s and paved the way for significant LGBTQ activism, particular the Stonewall rebellion. The Stonewall Inn rebellions in Greenwich Village were a series of spontaneous riots lau In 1983, Larry Kramer (1989) published the now infamous essay, 1,112 and Counting It which served as a call to action to address Gay Related Immune Deficiency (GRID), which was rapidly killing many gay men. CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 4

Complementary Approaches Psychodynamic theory: Much like the larger social context in which it was developed, many scholars and practitioners of psychodynamic theory framed homosexuality as a form of pathology and perversion throughout much of the 20th century (Fairburn, 1952; Winnicott, 1964 This oppressive and discriminatory legacy is best represented in the diagnosing of homosexuality as a form of pathology in early versions of the DSM and still lives on today in the attitudes of some analysts trained during the early to mid-20th century (Bartlett, King, & Phillips, 2001; Phillips, Bartlett, & King, 2001) Despite this historical precedent, several current psychodynamic scholars and practitioners have moved beyond framing same-sex desire as pathological and problematic, or at least viewing it essentially as such. Proponents of self psychology aim to help the individual have a greater realization of self and to experience their identity, past, as well as relationships with maturity and congruence (Flanagan, 2008). Affirmative practice helps LGBTQ individuals make sense of their experiences of heterosexism, homophobia, and other forms of oppression and helps integrate that history into the individual’s present identity (Kertzner, 1999 ). CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 5

Complementary Approaches Social constructivist, postmodern, and narrative approaches: Postmodern and constructivist approaches to social work practice recognize that knowledge is socially constructed through time and context bound experiences and the meaning individuals, groups, communities, and systems place on those experiences (Payne, 2014) Within this paradigm, socially constructed knowledge is never static; it always has the potential for change as experiences and meaning attribution evolve over time Situated in Foucault’s philosophical work and constructivist and postmodern approaches to clinical practice, narrative therapy evolved out of the fields of couple/marriage and family therapy in New Zealand and Australia during the late 1980s (Besley, 2002) Narrative therapy can be most impactful as the practitioner assists the client in re-telling the story of their life in less problem driven and more functional and strengths-based ways (Freedman & Combs, 1996; White & Epston, 1990). CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 6

Complementary Approaches Cognitive-behavioral approaches: CBT is a widely used approach in social work that actively works to change maladaptive ways of thinking and behaving (Butler, Chapman, Forman, & Beck, 2006) Social workers using CBT within a strengths and affirming practice paradigm should focus on patterns of thinking and behaving that are functional for LGBTQ individuals For example, when working to reduce internalized homophobia or heterosexism, social workers should focus attention on hopes, visions, talents, and abilities (Saleebey, 2009) instead of self-defeating thoughts CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 7

Gay Affirmative Approaches o Gay-Affirmative Psychotherapy (GAP) emerged in the 1970s and 1980s from a need for counseling practice that was free from heterosexist bias. o GAP works from the assumption that sexual orientation and gender identity/expression are normal expressions of human sexuality and identity (Kort, 2004). o Kort, a Michigan social worker specializing in gay-affirmative practice, argues that gay-affirmative services promote self-acceptance of sexual orientation and gender identity/expression (2008). o Kort states that affirmative practice goes beyond being tolerant or friendly to LGBTQ issues. Indeed, it’s not even enough for the social worker to be LGBTQidentified. oAffirmative practice means celebrating sexual orientation and gender identity/expression as a form of diversity that adds to the richness of our society (Kort, 2008). CHAPTER 17: PRACTICE WITH THE GAY MALE COMMUNITY 8

Gay Affirmative Practice Scale o Attempts have also been made in social work to measure LGBTQaffirmative practice methods. One of the most widely used measures in social work for LGBTQ-affirmative practice is Crisp’s (2006) Gay-Affirmative Practice (GAP) scale. o Conceptually, GAP in social work views LGBTQ individuals from the person-in-environment perspective and recognizes that LGBTQ individuals have strengths that help them cope with homophobia and heterosexism. o Further, GAP emphasizes that cultural competence is necessary in working with LGBTQ individuals; that LGBTQ identities are just as healthy as non-LGBTQ identities; that social workers should help LGBTQ individuals negotiate the challenges of deciding when and if “coming out” makes sense for them individually; and that social workers must engage in raising consciousness about the ongoing and challenging role of homophobia and heterosexism within society. CHAPTER 17: PRACTICE WITH THE GAY MALE COMMUNITY 9

Conclusion Affirming and strengths-based practice models include a range of safe, supportive practice models that celebrate sexual orientation, gender identity and expression LGBTQ individuals experience many of the joys and struggles of ordinary human experience yet are challenged by stigma-related experiences that occur in everyday life LGBTQ affirming and strengths-based social workers and other practitioners assist individuals and communities to enjoy the rewards of fully participating in society LGBTQ individuals and communities have a variety of interpersonal strengths and community support systems from which they may draw upon in time of need CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 10

Case Scenarios The following case scenarios will highlight some potential practice issues for the LGBTQ affirmative social worker. The cases may be used as in-class group assignments or for homework based on the needs of the course. Each case is followed by several questions for consideration. CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 11

Case Scenario 1: Lois Lois is a 32 year old White female who identifies as a lesbian. Lois presents for services after an end to a 3 year romantic relationship. For the past two months, Lois has felt depressed and has been absent from work. She is in danger of losing her job. CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 12

Case Scenario 1: Questions for Consideration Consider the following questions with regard to your work with Lois: 1. As part of the initial assessment, how would you engage Lois in naming her strengths and resources? 2. How can existing relationships in the community help Lois mange her feelings of depression? 3. In what ways might employment or other activities of daily living be a strategy for coping with the loss? CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 13

Case Scenario 2: Dean Dean is an 18 year old bisexual male who was recently kicked out of his parents house after coming out as bisexual. Dean has been out for several years to his high school peers. A number of his peers’ parents are supportive. He is temporarily living with one of his peer’s parents. CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 14

Case Scenario 2: Questions for Consideration Consider the following questions with regard to your work with Dean: 1. What further information could be helpful in assessing relationships within Dean’s family? 2. In what ways might Dean’s relationships in the community be used as an asset for building his relationship with his family? 3. How has Dean successfully coped with family relationships in the past? CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 15

National Resources and Web Links Resiliency in Action https://www.resiliency.com/ Appropriate Therapeutic Responses to Sexual Orientation https://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf Association of LGBTQ Psychiatrists http://www.aglp.org/ CHAPTER 11: AFFIRMING AND STRENGTHS BASED MODELS OF PRACTICE OXFORD UNIVERSITY PRESS 16

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