Compassion, Countertransference, and Counterreaction to LGBTQ+ Youth
This chapter opens Part II with the first of two chapters on the individual level of caring for LGBTQ+ youth. This one demonstrates how clinicians and educators can practice compassion strategies and interventions (Gilbert, 2009) while caring for/educating LGBTQ+ youth. Since it’s for the professional, it also addresses the countertransference/counterreactions that can arise and interfere with compassion, education, and treatment. The role and prevalence of trauma in the lives of LGBTQ+ youth is disproportionately high, inviting self-loathing, rejection, abuse, abandonment, homelessness, and suicidality.
These consequences can be mitigated with interventions that promote acceptance, commitment, and the willingness to take action to relieve suffering.
However, clinicians and educators need cognitive and emotional flexibility, which are key aspects of Acceptance and Commitment Therapy (ACT), to do so. This chapter explores and improves the biases and reactions that impede educating and treating LGBTQ+ youth.
BIAS BLITZ
LEARN
Whether we realize it or not, we all hold implicit biases. One way of managing bias is by acknowledging it and cultivating less judgment. The following questions can facilitate awareness of bias, for the purpose of releasing it.
PRACTICE
What are all the myths you hold/held/heard/believe/believed about LGBTQ+ people? List everything, including incomplete thoughts and single words. No judgment, just let it flow out.
Could you see yourself letting go of any of the beliefs or values listed above? If not, that’s ok; ask yourself why and write the answer here.
Have you ever noticed your views affecting the treatment you offer? Would your patient feel okay hearing about some of your views? Explore the ways views/beliefs/values keep people separate and impact relationships.
REFLECT
• Self-kindness and self-acceptance arise when we integrate the darker parts of our personality.
• When working with LGBTQ+ youth, it’s important to know where your biases lie. It’s one step towards identifying and integrating your shadow/dark parts.
• If you’re not ready to explore your biases yet, it’s ok. Many people aren’t. See if you can be open to it one day.
• If you looked at your biases, and don’t know what to do with them, or feel ashamed or overwhelmed, it’s ok too. These are common reactions. Letting go of maladaptive patterns requires looking at them and acknowledging them first. Way to go!
• Seeking consultation is another way to overcome bias and bring even more meaningful and effective treatments and pedagogies to LGBT+ youth.
What are all the myths you hold/held/heard/believe/believed about LGBTQ+ people? List everything, including incomplete thoughts and single words. No judgment, just let it flow out.
Could you see yourself letting go of any of the beliefs or values listed above? If not, that’s ok; ask yourself why and write the answer here.
Have you ever noticed your views affecting the treatment you offer? Would your child feel okay hearing about some of your views? Explore the ways views keep people separate and impact relationships.
*Modification:
When working with large groups of people (professionals or students), divide the group up into “families” of 8-12 people. Invite the “families” to verbally discuss the questions on this page.
This can also be used as an oral activity in families, when their LGBTQ+ youth is not present.
COUNTERTRANSFERENCE, COUNTER-REACTION, AND TRANSFERENCE
LEARN
Countertransference, counterreaction, and transference are experiences that happen in the therapeutic relationship. They mimic instances that arose in other relationships, and when processed tenderly, can be released and cleared. These three types of experiences also arise between teachers and students, parents and their kids, even between partners, friends, and lovers. Super tricky stuff to track and utilize in the moment, but it is possible!
Definitions:
Transference reactions arise in therapeutic relationships when individuals experience unconscious reactions, beliefs, feelings, attitudes, and values about/towards their clinician.
This can also happen in school settings. For example, a teacher may be on the receiving end of a transference type of reaction when a student comes out to the teacher and expects them to react as their own father or mother would. When this happens in relationships that are not clinical or therapeutic, the experience is called “recapitulation” instead of “transference.” Generally, transference and recapitulation mean the same thing. The only difference is transference happens with a clinician; recapitulation can happen with anyone, anywhere, at any time.
Countertransference is a clinical term for feelings clinicians unintentionally experience when working with LGBTQ+ individuals. This phenomenon is not exclusive to LGBTQ+ individuals; however, it does carry unique significance if the clinician has unresolved relationships, issues, and problems related to their gender and/or sexuality. Countertransference can be a big problem in therapy and requires great strength, skill, courage, sensitivity, and self-kindness to be of use to both the therapist and the LGBTQ+ youth they work with. Let’s just say that managing countertransference is a master clinical skill. In clinical relationships, the power of countertransference lies in how the clinician uses it to understand LGBTQ+ youth. Beginning to notice it is a kind and mindful approach to relationships of all kinds. In all relationships other than the clinical kind, these types of reactions should be treated as your own recapitulation reaction to LGBTQ+ youth.
Counterreaction is another kind of experience that can happen to clinicians, parents, educators, and other professionals, too. The difference between counterreaction and countertransference is the former is typically a reaction anyone would have to the person in question. The latter, countertransference, arises when the clinician’s unresolved issues are triggered by the LGBTQ+ youth they care for. Both the teacher and the student, clinician and patient, or parent and child can unconsciously remind one another of past relationships and incidents. Without any awareness that this is happening, adults can unwittingly be reactive, instead of being responsive and reflective. Counterreactions and recapitulations happen in all relationships. Gaining mindfulness about them leads to increased empathy and compassion for LGBTQ+ youth.
PRACTICE: EXPLORING INTERNAL BIASES
What are your internal biases? Take a deep breath and truly dig deep inside and see if there are any biases you hold. It’s safe. Only you need to write, see, and/or become aware of them.
How might you offer yourself kindness and acceptance while acknowledging you hold biases?
How might you offer kindness and acceptance to LGBTQ+ youth who may be different/similar to you and evoke a wide range of feelings, beliefs, values, memories, desires, aversions, etc.?
How might you find acceptance of the ever-changing nature of your thoughts and welcome new ones? Could you imagine yourself having a beginner’s mind, becoming a child again, if you will, and listening to LGBTQ+ youth and the important information they share?
Can you imagine being truly open to LGBTQ+ youth, as if they are experts beyond their years, and even beyond your experience and training? See if you can offer them this heightened level of respect and empathy; with it you grow as an adult who cares for young people.
REFLECT
• Don’t believe everything you think.
• When you reduce the tendency to interpret thoughts, images, feelings, and memories as the grounds for reality, you also begin resisting implicit and automatic bias.
• Resisting bias is especially important when working with LGBTQ+ youth because their authentic nature is inconsistent with the dominant culture and they are subject to stereotyping, bias, and harm as a result.
• Internal and implicit biases are harmful in subtle and insidious ways. Avoiding them requires heightened awareness and sensitivity, as well as the willingness to release assumptions and entertain new ideas.
• To go even deeper, and release more bias, return to the Bias Blitz on page 104. Completing it, along with the exercise on the previous page, increases your mindful awareness about your implicit biases.
PRACTICE: CLEARING COUNTERTRANSFERENCE
List all the trigger issues you have. Trigger issues are events, smells, tastes, music, sounds, tactile sensations, personality types, anniversaries, holidays, rituals, etc. that elicit a spontaneous negative reaction. They are usually unresolved issues. (For example: Sometimes people are irrationally angry in traffic; road rage can be elicited by a host of unconscious trigger issues the driver encounters.)
Now, take a deep breath all the way down into your belly. Finding contact with your body, allow yourself to truly come into the present moment. Take as long as you need, and breathe as many times as feels right to you. Next, see if any other trigger issues come to mind. Give yourself time to let things rise to the surface. It’s ok if nothing does.
Are there any youth you prefer to avoid? Describe them? Why do you avoid them?
Whom do they remind you of?
REFLECT
• Upon completion of the questions above, allow yourself a moment to honor your courage and bravery in facing unresolved issues that may lead to countertransference.
• Your bravery and courage in this area are forms of strength in vulnerability, and cultivate mindful awareness.
• Try to practice bringing this level of mindful awareness to your LGBTQ+ youth. They need it and the deep empathy and compassion that follow.
PRACTICE: DIFFERENTIATING BETWEEN COUNTERTRANSFERENCE AND COUNTERREACTIONS TO LGBTQ+ YOUTH
List times when you reacted to LGBTQ+ youth in a way that is consistent with how you would react at home, in private, and with family or friends. We all have unresolved issues; nothing to be ashamed of. Find times when your unresolved issues drove your reaction to LGBTQ+ youth.
Explore all the times you reacted to LGBTQ+ youth in a way that others might, too. For example, some people are curio us/fascinated/obsessed/disgusted/in different to transbodies. This range of reactions can be based in values, cultural messages, or some type of reaction that some people have to others who are different.
Counterreactions tend to be arousing, yet less triggering and emotionally inflaming than countertransference. Have you ever had a reaction to LGBTQ+ youth where it was excessive, intense, strong, or completely flat and absent? Some people react with curiosity and/or confusion. Explore these times.
REFLECT
• Differentiating between counterreactions and countertransference can be tricky.
• Set the intention to be on the lookout for your own reactions, and take time to analyze them.
• Seek out a clinician who specializes in clinical supervision to further explore this topic. Sometimes therapy is needed for clinicians and/or educators, and can be helpful.
PRACTICE: MANAGING LGBTQ+ YOUTH TRANSFERENCE REACTIONS
Have you ever worked with LGBTQ+ youth and suddenly, they’re upset/pissed off/angry/reacting strongly to/disappointed in you? Did it come as a surprise? Were you expecting it because of their history and how you know them? Why/why not?
LGBTQ+ youth transference reactions to clinicians and/or teachers could arise at any time. If one does, see if you can pivot the angle of your perception towards LGBTQ+ youth so you see the problem through their eyes—as if you’re not even part of the interaction at all. This is hard stuff; mental gymnastics, for sure! Plus, it requires a lot of self-regulation and composure to not react. Write down any thoughts that come to mind.
LGBTQ+ youth face high amounts of abuse, discrimination, threat, intimidation, and rejection. When they begin to have intense reactions, see if you can offer them compassion. Compassion could include accepting and reassuring comments. List compassionate comments here.
Tell LGBTQ+ youth that they can expect to have strong reactions to people at times. It’s a typical reaction to being treated unfairly in the media, in school, in politics, at home, or anywhere actually. In the space below, record the thoughts you might share with LGBTQ+ youth to show them their strong reactions are understandable. Sometimes, it diffuses the power and intensity of the reaction. Feel free to share a time when you had a strong reaction—telling the LGBTQ+ youth about it may normalize and validate their experience.
REFLECT
• Mindful awareness can be defined as balanced open awareness, with interest, curiosity, and receptiveness. Helping LGBTQ+ youth gain awareness and acceptance of their reactions inspires self-compassion.
• When LGBTQ+ youth self-reflect on their intense reactions, they begin to access their higher Self, an infinite source of wisdom.
• Self-kindness for transference reactions is an effective method of coping with anxiety and depression, both of which can be compounded by transference reactions.
COMBINING ACCEPTANCE, COMMITMENT, AND COMPASSION
LEARN
The impact of discrimination and harm on LGBTQ+ youth is significant. Consequences can be mitigated with practices that promote acceptance, commitment, and the willingness to take action to relieve suffering. However, clinicians and educators need cognitive and psychological flexibility, which are key aspects of Acceptance and Commitment Therapy (ACT), to do so. The following key aspects of ACT are adapted into the following questions for use in self-managing countertransference, counterreaction, unintended bias, and youth transference.
1. Cognitive defusion: reduce the urge to make thoughts, images, emotions, and memories the basis for reality
2. Acceptance: flexibly noticing thoughts while remaining open to new ones
3. Mindful awareness: balanced open interest and receptiveness
4. Self-reflection: accessing the higher self, the infinite source of wisdom within each person
5. Values: assessing beliefs and importance of issues to clinicians, educators, LGBTQ+ youth, and their parents
6. Committed action: executive functioning, combined with the willingness to take action
PRACTICE
1. What thoughts, images, memories, and emotions come to mind when you think of LGBTQ+ youth?
2. Do these thoughts, images, memories, and emotions become the basis for your judgments and interpretations? Could you be open to other ideas?
3. Mindful awareness is balanced open interest and receptiveness of whatever is happening in the moment. When you interact with LGBTQ+ youth, are you present to their views, emotions, impulses, fears, inhibitions, etc.?
4. People often think about their experiences and next statements when listening to others. A mindful approach filters out self-centered thinking and focuses the light of attention squarely on the other person. See if you can catch yourself not being present, and re-align your attention with the LGBTQ+ youth you work with. Has it happened before? It’s ok! It’s quite common. The act of re-aligning attention on the other person is the practice of becoming more mindful. Record your reactions here.
5. Some experts (Dabrowski, 1964; Hayes et al., 2016; Siegel, 2014) see great value in sourcing information from within. They describe the need, and the way, some people access their higher wisdom, even if it means going against the dominant culture, their religion, or family. For LGBTQ+ youth, this is already arising and can be harnessed for even greater growth and healing. How might you assist LGBTQ+ youth in cultivating and pursuing their inner wisdom?
6. In the space provided, explore your values and how they are different or similar to the LGBTQ+ youth you work with. How important are these issues to you? Start by rating them on a scale of 0-10, where 0 is “not at all” and 10 is “extremely.”
7. How might you suspend your values and proceed with the values of the LGBTQ+ youth you interact with?
8. Committed action is a series of steps one can take to relieve suffering, promote joy, and thrive. Executive functioning is another way of looking at committed action because it delineates the actions involved in achieving an end goal. The steps in executive functioning are:
a. Set a goal
b. Make a plan
c. Carry out the plan and self-monitor to see if the plan is working
d. Adjust the plan as necessary to increase the likelihood of success
When combined with mindful awareness and loving kindness, the willingness to take action can heal and relieve suffering. On the lines on the next page, explore your committed action steps, as well as those of the LGBTQ+ youth you work with.
| Clinician/Educator |
LGBTQ+ Youth |
a. What is your goal in serving LGBTQ+ youth? |
b. What is the goal of the LGBTQ+ youth you care for? |
c. What is your plan for achieving this goal? |
d. What is their plan? |
e. Identify 3 areas you will self-monitor while carrying out your plan. |
f. Identify 3 areas they may wish to self-monitor while carrying out their plan. |
a.
b.
c.
d.
e.
f.
REFLECT
• The eight practice steps/reflections in this practice correspond with Acceptance and Commitment Therapy principles (Hayes et al., 2016).
• When applied to LGBTQ+ youth, these eight steps create a framework within which clinicians and educators can suspend personal values, cultivate mindful awareness, and successfully act to relieve suffering.
• It’s a lot to think about all in one moment, but even if you only acquire one aspect of the eight steps listed, it can soften the experience of LGBTQ+ youth and increase the likelihood of successful outcomes.
COMPASSION CIRCLES FOR WORKING WITH LGBTQ+ YOUTH (GILBERT, 2009)
LEARN
In his book The Compassionate Mind, Paul Gilbert states that compassion evolved out of our capacity for altruistic and caring behaviors. Behaviors such as guiding, helping, protecting, and caring for others constitute compassionate action. Gilbert suggested that these behaviors can be cultivated with attention and warmth.
Gilbert declared that compassion circles can be intentionally cultivated with others, and with ourselves. With concern for LGBTQ+ youth, it’s helpful to develop any or all of the competencies and attributes included in Gilbert’s compassion circles. It’s an important step towards minimizing judgment and implicit bias, while increasing the level of care and attention directed towards vulnerable LGBTQ+ youth.
PRACTICE
Attributes and competencies featured in Gilbert’s Compassion Circles:
• Non-judgment
• Empathy
• Distress tolerance (of your own distress and that of the LGBTQ+ youth you care for)
• Sympathy
• Sensitivity
• Care for well-being
SKILLS:
• Attention
• Feeling
• Sensory
• Imagery
• Reasoning
• Behavior
REFLECT
• When the skills and attributes above are cultivated, compassion circles are in action.
• When cultivated with warmth and directed towards LGBTQ+ youth, compassion circles have the potential to ripple out with incredible acts of life-affirming kindness and progress towards equality.
SELF-COMPASSION WHEN WORKING WITH LGBTQ+ YOUTH
LEARN
Self-compassion is cultivated with four different practices (Gray, 2016):
i. Mindful awareness
ii. Self-kindness
iii. Shared humanity (remembering we all suffer at some point, in some way)
iv. The willingness to take action to relieve your own suffering
When working with LGBTQ+ youth, clinicians and educators are exposed to increased reports of distress, victimization, trauma, and suicidality in comparison to other youth populations. Selfcompassion practices are important self-care tools that reduce the risk of burnout/compassion fatigue.
PRACTICE
• This is a reminder to practice meditation or mindful awareness practices for you!
• It is also a gentle reminder to be kind to yourself, but you already know that!
• And remember, when you are suffering, you are not alone. There are others suffering along, just as there were before and will be afterwards, too.
• Finally, if you need to take action to care for yourself and relieve your own suffering, please do so. It’s not just helpful for you; all of humanity benefits when you care for yourself—especially the LGBTQ+ youth you care for.
REFLECT
• Some people find it easier to care for others than to do so for themselves. Does this happen to you? If so, reflect on a new concept:
“Your offering to others is only as vast as the gifts you bestow upon yourself!”
• Being a clinician or educator of LGBTQ+ youth involves great responsibility. How might you care for yourself, be kind to yourself, and take action when necessary so that your service to LGBTQ+ youth meets their needs?