Introduction

Welcome!

This book is divided into two parts: The first part is for clinicians/educators to use with youth, and includes informative and engaging mindful awareness practices, guided meditations, exercises, and opportunities for LGBTQ+ youth to self-reflect with meaningful handout pages. The second part focuses on Individual, Family, & Community Level interventions for the clinician and/or educator, from an ecological systems perspective. Specific tools, activities, forms, and practices are included for professionals to use in treatment and lesson planning, school care, family counseling, and community advocacy. Self-reflective activities for the professional are also included, in this part, to reduce countertransference, counterreaction, implicit bias, and stereotyping.

Chapter One begins with lesbian, gay, bisexual and questioning identification development, as well as coming out.

LGB&Q+ identity development is introduced with definitions and terminology, then explored by building on the work of Kinsey, and later Klein. (Transgender and intersex identity development will be addressed separately, because the evolution of gender differs from sexual orientation identity development.) Internalized homo/bi-phobia are obstacles youth must overcome to integrate their authentic identity in a healthy way. Moving from one identity to another, from cultural acceptance to cultural threat, complicates the identity journey teens already go through in reaching adulthood. However, it need not be painful, and can be quite joyful!

The exercises and worksheets in Chapter One focus on: terms & definitions, sexual orientation identity formation, and the complexity of sexuality. The decision to come out can involve safety risks. Safety planning is also included in the worksheets provided so LGBTQ+ youth can plan and create coming out strategies that promote their health and well-being. The chapter closes out with how LGB&Q+ youth can talk with others about their identity.

In Chapter Two, on Lesbian Youth, issues like invisibility, increased need to facilitate positive self-regard and self-worth, as well as sexual health and development are presented. Homophobia, misogyny, and transmisogyny originate in society, but can infect the internal experience of lesbian youth. For these reasons, the chapter directly addresses the negative impact of these attitudes. Dating and wanting and initiating sex are also themes that arise for some lesbian youth. Assisting them in managing these and related issues, like sleepovers, sex, and parents are also included in Chapter Two. Drug and alcohol use is quite high in the LGBTQ+ youth community, and especially so among lesbian youth. As such, this issue is addressed with a self-test youth can take to explore the nature of their substance use. Finally, lesbian youth in sports represent a unique population and are addressed here in an effort to mitigate the challenges faced in competitive sports.

Chapter Three, on Gay Youth, discusses male gender role expectations, and how being gay expands beyond norms, among other issues, too. Research shows that gay identity development in adolescence is correlated with intimacy, relationship fulfillment, and intimate partner violence (Edwards & Sylaska, 2012.) Sexual health and the impact of the HIV crisis endures in gay communities, and therefore deserves some elucidation as young gay men develop. With substance use also a concern in the gay community, it is explored with a self-test youth can take to assess their use. Body image is also addressed, as it is a clinical concern for some gay youth.

Understanding bisexuality as a legitimate and distinct identity remains a crucial concern that impacts youth who love males, females, and more. Chapter Four, on Bisexual Youth, explores the nuances and struggles of youth loving diverse humans. The harmfulness of bisexual erasure is addressed, along with a self-test (in Appendix D) for substance abuse owing to the very high risk of addiction in bisexual youth (Marshal et al, 2008).

The focus shifts away from sexual orientation to gender identity in Chapter Five, on Transgender and Intersex Identity Development. Exploring options for gender expression, gender expansiveness, and gender expansive youth are introduced along with definitions of terms. The rainbow of gender identities and expression are elucidated in the Gray Gender Spectrum exploring multiple dimensions of gender identity, as well as how expression varies over time. Since not all who are gender expansive wish to transition, some issues are introduced here and followed up in Chapter Seven on Questioning Youth. The fluidity of gender is explored with details about how to identify and treat gender dysphoria. Differential diagnosis with body dysmorphic disorder is easy when the contrast is highlighted. Moreover, self-love and body confidence can increase with clinician and educator sensitivity. Names and pronouns are a unique clinical theme that emerges for transyouth. Chapter Five shows professionals how to address this key issue. Internalized transphobia can complicate healthy gender identity development and/or transition; therefore, it is explored here with some education presented in interactive worksheets. Finally, the chapter concludes with a brief exploration of intersex identity development and the unique features of identity development that follow this biological condition.

Chapter Six, on Gender Transition, promotes collaboration between clinicians and youth in assessing need/desire for gender transition. It guides transition with influence from the World Professional Association of Transgender Health (WPATH) and the Harry Benjamin Standards of Care (7th Revision) so clinicians can feel comfortable documenting for risk management. Clinicians who worry about authorizing and facilitating transition can use tools from this chapter to collaborate, affirm, empathize, and care for gender expansive youth. Looking at which aspects of transition appeal and which don’t helps transyouth discover the kind of transition (if any) that is best for them. New to the literature are the concepts of Developmental Gender and Chronological Gender. These terms capture the unique trajectory of development that transpeople go through if and when they decide to transition. The chapter also shows professionals how to assess the level of distress transyouth feel about their gender. This assessment is critical to affirming transition because it documents how greatly transyouth suffer.

Gender and sexuality can feel rigid and defined, especially in our culture. Questioning youth, addressed in Chapter Seven, remind us that this is an illusion. Chapter Seven explores fluidity and openness to both gender and sexuality. It offers youth and professionals an opportunity to explore sexual and gender identity, with openness and without the need to label. For some people, this is a stage they pass through before realizing they are gay or trans. For other people, being queer is the state of being. It can also be a period of exploration for youth who may ultimately decide to transition. Whichever need it serves, let it be a time of celebration, curiosity, and love.

Part II of this book changes in focus and audience, as it is intended primarily for the professional who works with LGBTQ+ youth in clinical and educational settings. The second part focuses on strategies and approaches to LGBTQ+ youth, from an ecological systems perspective.

Bronfenbrenner’s (1979) ecological systems theory suggests that people are part of an interconnected, yet related, system with the individual at the center. LGBTQ+ youth, for example, are inseparable unique elements of a social network, and are simultaneously impacted by the social network. When empathizing with LGBTQ+ youth through the lens of Bronfenbrenner’s ecological-systems theory, they are understood in terms of the impact surrounding systems have upon them. This is the framework used for Part II, and also for understanding Educational Trauma, which severely impacts LGBTQ+ youth.

The first chapter in Part II is one of two that address the individual level of ecological systems. It focuses the professional’s attention to their reactions and biases in order to deepen the level of compassion offered to LGBTQ+ youth. It demonstrates how to apply compassion strategies and interventions (Paul Gilbert) to LGBTQ+ youth, as well as how to manage the countertransference/counterreactions that interfere with compassion and treatment. LGBTQ+ youth can present with very strong transference reactions. This phenomenon is explained for clinicians and educators, along with tips for how to respond in a favorable and helpful manner. This chapter also applies Acceptance and Commitment Therapy (ACT) principles to LGBTQ+ youth and their unique concerns, and concludes with Paul Gilbert’s (2009) compassion circles.

Chapter Nine shows professionals how to introduce self-compassion practices to LGBTQ+ youth. Self-compassion is associated with decreased depression and anxiety, as well as increased well-being. When applied to LGBTQ+ youth, the power arises in mitigating the effects of the extreme discrimination they face. Because of the role and prevalence of trauma in the lives of LGBTQ+ youth, they experience disproportionately high self-loathing, rejection, abuse, abandonment, homelessness, and suicidality. Reducing the risk of dissociation and decompensation due to increased rates of traumatization is an important clinical responsibility when treating LGBTQ+ youth. Self-compassion strategies for LGBTQ+ youth are offered in the Self-Compassion Training Protocol for Traumatized Teens (Gray, 2016), adapted for LGBTQ+ youth, to promote healthy forms of courage, vulnerability, bravery, and self-kindness. Trauma effects can be mitigated with interventions that promote acceptance, commitment, and the willingness to take action to relieve suffering. However, professionals need cognitive and psychological flexibility, which are key aspects of Acceptance and Commitment Therapy (ACT), to do so. The key aspects of ACT are adapted into worksheets for clinicians to use in self-managing countertransference, counterreaction, unintended bias, and LGBTQ+ youth transference, too.

Chapter Ten takes a look at how to collaborate with families of LGBTQ+ youth. It includes offering safety for parental reactions of grief, loss, disappointment, resistance, fear, aversion, worry, and sparing youth from these reactions. Interventions are offered to help clinicians assess and explore the family’s readiness to support LGBTQ+ youth. The importance of parental support in long-term outcomes for LGBTQ+ youth influences this chapter. Religion is also explored as it can be a strong confounding variable in the development of LGBTQ+ youth.

To conclude this workbook, Chapter Eleven looks at the community level and how to make schools safe for LGBTQ+ youth. This angle rounds out Part II, by offering strategies for creating GSAs and Safe Zones in schools, where LGBTQ+ youth know they can speak freely. Social justice in schools is an ethical responsibility for school counselors. This chapter shows professionals how to meet this ethical standard with a checklist and a shortened questionnaire to assist efforts. Form letters are included to inspire professionals to act on behalf of LGBTQ+ youth bullied, mistreated, and/or having bathroom/locker room issues. Knowing how to speak with and train youth and other professionals in being kind to LGBTQ+ youth is critical to making schools safe, which is why this is a focal point of Chapter Eleven. Finally, it covers the heinous effects of the school-to-prison pipeline, and the steps professionals can take to do their part in dismantling it.

There are six appendices included in this workbook. The first one contains resources that may be important to LGBTQ+ youth and the adults in their lives. Appendix B holds handouts for parents, including activities and facts/stats/data sheets. Appendix C is instructions for the Loving Kindness practice, which supports several elements of cultivating self-compassion. Appendix D is a substance abuse self-test developed for LGBTQ+ youth to self-assess their use of drugs and alcohol. It is followed by Appendix E which includes forms from Gender Spectrum to guide professionals in supporting students who are transitioning and/or gender expansive. Appendix F includes possible statements and responses to common questions parents and others have about teaching gender, supporting gender-creative students, and facilitating inclusive affirming.

Worksheets and exercises that are boxed in are meant to be reproduced and given directly to youth.