Group Intervention for the Treatment of Internalized
Homophobia in LGB Adolescents
Jared Smith
University of Dayton
Abstract
Lesbian, gay, and
bisexual (LGB) clients are often faced with negative wellness outcomes due from
complications of living in a heterosexist world and dealing with the stress and
pressure associated with minority status.
While the external world is full of threats and must certainly be
navigated, there is another component which must also be addressed. Internalized homophobia is an internal
dissonance of self- expectation. The
process of growing up in a heterosexist world often results in negative
stereotypes about LGB status being turned inward. The following group proposal will attempt to
reduce and mitigate internalized homophobia and increase self-love and personal
mastery through the use of cognitive behavioral, acceptance and commitment,
psychoeducational, and gay-affirmative techniques.
Introduction
Sexual minority clients have a higher risk of serious
mental illnesses, negative health outcomes, and emotional distress than
majority client members. Research
suggests that many of these negative outcomes are partially due to homophobia
which exists and is institutionalized in the heteronormative society around us.
McGeorge and Carlson (2011) summarize the effects of heterosexism on LGB
individuals:
“The literature also clearly documents the
negative influences of heterosexism on the relationship experiences and mental
health of LGB persons. Examples of these negative influences include increased
rates of depression and anxiety (Bernhard & Applegate, 1999; Bos, van
Balen, van den Boom, & Sandfort, 2004; Lewis, Derlega, Griffin,
& Krowinski, 2003; Mays & Cochran, 2001); suicide (Bernhard &
Applegate, 1999; Faulkner & Cranston, 1998; Garafalo, Wolf, Kessel,
Palfrey, & DuRant, 1998; Gibson, 1989; Mays & Cochran, 2001); and
alcohol and drug misuse (Cheng, 2003; Faulkner & Cranston, 1998; Garafalo
et al., 1998; Jordan, 2000; Kruks, 1991).”
What becomes complicated is that this
disadvantageous system which effects our clients is not only externally
influenced. Alas, the result of growing
up in a homophobic society is the internalization of homophobia. In order for self- actualization of sexual
identity to come to fruition, this internal struggle must be dealt with and the
wounds of internalized homophobia must be healed. This proposal includes a review of literature
poised at creating a safe group environment wherein internalized homophobia can
be measured, and reduced. The proposal
suggests a technically eclectic approach with foundations in
cognitive-behavioral therapy supplemented with psychoeducation, strength based
techniques, gay-affirmative techniques, and acceptance and commitment
techniques.
It is important in
therapy that we always consider the influence of culture on clients. When dealing with LGB individuals, this can
be complex. Homophobia may be a very
real part of your client’s external environment as it is institutionalized and
built into the society around them. But
what about the homophobia that comes from within? Research suggests that growing up in a
homophobic world leads to internalized homophobic values and self-concepts. An LGB client will have to battle not only
with the world around them, but the world inside of them.
Literature Review
It is our job as practitioners to use empirically
grounded and culturally applicable treatment plans when treating our
clients. Certainly, the LGB population
is no exception. There have been many
different schools of thought on the issue of helping LGB individuals toward
acceptance of self, and reduction of comorbid conditions that tend to correlate
with LGB status. The approach that will
be utilized in this group proposal will be that of a technical eclectic
approach. A framework of cognitive
behavioral theory will be used as the platform upon which additional techniques
will be supplemented. From there, a
strong psychoeducational piece will be utilized as a supplement to
treatment. The treatment component in
addition to the CBT frame will include techniques from Gay-Affirmative and
Acceptance and Commitment models.
Although the core of content will be focused from a CBT perspective,
group members will find that group dynamic and process design also borrow
person-centered tenants of unconditional positive regard, congruence, and
empathic understanding in order to facilitate an environment of growth which
will feel safe to clients.
Cognitive-Behavioral
Therapy
The
basic framework on which the internalized homophobia reduction techniques will
be built will be that of a cognitive behavioral perspective. This is a very deliberate decision and is
based on research which suggests that cognitive behavioral approaches work well
with adolescents (Craig Austin & Alessi, 2012; Compton et al., 2004). It will also be useful in achieving our goal
of reducing internalized homophobia and increasing acceptance because of the
models’ focus on recognizing maladaptive thought patterns, reality testing, and
cognitive restructuring of accompanying beliefs. CBT focus was also chosen due
to its “homework” components which will encourage group members to take the
personal growth and insight gained in the group setting and apply it to their
lives outside of therapy. The fact that
these cognitive-behavioral principles will be utilized under a group setting
will also have the added benefit of providing a support system should these
attempts to integrate therapeutic outcomes with their lives not go as planned,
and a system of peer accountability to encourage members to continue their work
outside of therapy.
Psychoeducation
In part because
this group is geared towards adolescents, there will be a strong
psychoeducational portion that will be utilized to help disperse accurate
information about LGB individuals to the group participants. This part of the group will be geared toward
informing group members about relevant information regarding sexual education,
STI and HIV/AIDS reduction through safer sex practices, rights and protections
belonging to LGB individuals, and community resources available to group
members. This psychoeducation provides
several purposes: helping to dispel myths and stereotypes associated with the
LGB population; reducing internalized homophobic beliefs; reducing risk and
symptomology of LGB related health issues; and creating future support networks
for the group members as they continue on in a heterosexist society.
Gay-Affirmative
Therapy
A Gay-Affirmative perspective
will be part of the lens through which the counseling group will operate. This
approach will be used in supplement to our existing CBT framework due to its
focus on LGB issues and its adaptability to being used simultaneously with
other models.
“Gay affirmative practice
is not an independent practice approach; it is used to enhance a practitioner’s
existing treatment model and can be incorporated into individual, couple,
family, and group work (Davies 1996). However, gay affirmative practice differs
from traditional treatment approaches. It views homosexuality as a normal
variant of sexual identity development, which, in turn, ‘‘affirms a lesbian,
gay, or bisexual identity as an equally positive human experience and
expression to heterosexual identity’’ (Craig, Austin, & Alessi, 2012). This positive approach to dealing with LGB
clients will allow for a safe and nurturing environment to be formed. The affirmative component will allow for
growth and help reduce internalized homophobia and increase acceptance through
client-counselor modeling, and validation of the clients experience as an LGB
individual in the world. The article Gay Affirmative Cognitive Behavioral Therapy
for Sexual Minority Youth: A Clinical Adaptation discusses use of the
existing ten component model of Gay- Affirmative therapy. The interventions and techniques drawn from
these ten tenants will be utilized throughout the group due to their focus on
affirming client experience and identity, building good rapport with the
client, and using cognitive restructuring in a lens which is used to question
the helpfulness of thoughts rather than their validity. As these components
focus on restructuring, homework, and collaboration the pieces fit nicely over
our CBT framework. The ten tenants found
in the article are listed are listed as follows:
1-Affirm the identities of
SMY during the assessment process.
2-Foster collaboration by
clearly explaining the process.
3-Identify the SMY’s
personal strengths and support networks.
4-Distinguish between
problems that are environmental and those that stem from dysfunctional thoughts
5-For
environmentally-based problems, help clients make changes that decrease stress,
increase personal strengths and supports, and to build their skills for
interacting with the social environment.
6-Validate clients’
self-reported experiences of discrimination.
7-Emphasize collaboration
over confrontation, with attention to client–therapist differences.
8-With cognitive restructuring,
question the helpfulness (rather than the validity) of the thought or belief.
9-Use client-identified
strengths and supports to help SMY develop a List of helpful thoughts.
10- Ensure that homework
assignments emphasize congruence with LGBQ culture as well as the client’s
stage in the coming out process.
Note: In the above
mentioned excerpt the term SMY is used to refer to Sexual Minority Youth.
Acceptance and
Commitment Therapy
I chose to also supplement this group with techniques
from Acceptance and Commitment therapy (ACT).
ACT is a good for dealing with coming to acceptance of one’s sexuality
because it delivers symptom reduction via accepting what cannot be changed and
creating a new relationship with thoughts, feelings and physical sensations. The goal of ACT is to renegotiate the power
the client gives their negative thoughts rather than attempting to eliminate
them. The ACT model is also heavily
reliant on both mindfulness techniques and metaphor, encouraging both present
moment awareness and deeper emotional awareness through creative thinking and
assessing and separating fact from judgment (Bowden T. & Bowden S.
2012). The model itself will be a good
fit for group intervention because the model works on six different and
interconnected areas of creating wellness.
These areas may be worked on in any order and the ACT model believes
that progress in one area leads to progress in the other areas. It is adaptable, which is helpful in the
group setting. The six tenants are referred to in the model as the “hexaflex”
and have been described as follows:
a. Defusion:
What sort of unhelpful thinking is keeping us stuck, this could be rigid rules,
self-limiting beliefs, harsh judgments, reason giving etc.?
b. Acceptance:
What experiences (thoughts feelings, sensations) is this person avoiding and
how? What are the costs of avoidance?
c. Present
Moment: How much time is spent dwelling on/ re-living the past, worrying about
the future, getting lost in thought?
d. Self-as-context:
how clients see themselves. “Are you your struggle or are you more than that?
Are you stuck and only able to see the problem from one perspective?”
e. Committed Action: whether the current actions
are helping the client get where they want to be
f. How
connected/ Dis-connected are the client from what matters to them.
(Bowden T. & Bowden S., 2012).
Purpose and
Objectives
The purpose of this group is to help young adults of
sexual minority status come into loving acceptance and understanding of their
sexual identity. The progress made in
creating loving acceptance of self will also lead to reduction of symptomology
considered to be comorbid with sexual minority status (anxiety, depression,
suicidality, etc.). The group will
provide an affirmative environment and education with a focus placed on
creating change by reducing internalized homophobia. The objectives are as follows:
·
Clients will leave the group with lower levels
of internalized homophobia than when they entered the group
·
Clients will be educated on issues pertaining to
sexual minority status
·
Clients will learn tools to help them create a
relationship of loving acceptance with themselves
·
Clients will develop sense of community and work
on interpersonal communication
·
Clients will form a less judgmental relationship
with their thoughts and learn how to combat cognitive distortions and negative
thought patterns
·
Self-esteem and self-efficacy of clients will
improve
·
Clients will learn to presentize their awareness
to come to a deeper understanding of themselves, the environment around them,
and the interaction of the two domains
Structure and Setting
The structure of the
group will consist of 8-12 adolescent youth whom identify as lesbian, gay or
bisexual. The group will take place in
an open room setting such as an empty classroom or small conference room as
seen in many office buildings, schools, and churches. The group will meet twice every week for a
total period of two hours per session. A 10 minute break will be provided after
the first 40 minutes of each session. Longevity
of the group will be based on CBT model which suggests intervention length of
7-12 weeks. As such, the program will be
built as a twelve-week program. The
group will be closed to new members to prevent the group from having to
repeatedly re-establish trust with newcomers. Members will be chosen based on
self-reported symptomology of difficulty of coming to acceptance of sexual
minority status. The room will be in a closed door setting to encourage
disclosure and feelings of safety in the group.
The group will be conducted in the format of a rounded chair
circle. As new clients join the group
the rules and norms of the group will be explained as a group.
Process
The content of the group will be set in advance as topics
of conversation to encourage education and awareness. Group activities will also be a part of the
group work on a regular basis. To
encourage trust within the group, each session will start with introductions
and a “highs and lows” check in. The
group schedule will be posted in advance to allow group members to prepare for
the topic, and do any activities that would have been required of them to
complete in the previous session.
Content will psychoeducational in design; however, process regarding
daily lesson will be more free-formed and open to group will.
Process will be based upon renegotiating relationships
with client’s negative thoughts and internalized homophobia. Topics of content
will be used as catalysts to process conversations. As present moment awareness is important to
the outcome improvement of clients, process will be present moment focused and
mindful activities will be intermittently used where applicable.
The leadership of the group will model acceptance and
affirmative attitude when treating group members. The group dynamics will be based on creating
a safe environment where empathy and trust is felt, and education and healing
can take place as the agreed upon goals of the group. Leadership will keep the group’s focus
initially on the topic of the night through the use of activities and hand-outs. Upon finishing the content portion, the group
leader will open the forum and allow for process of the topic to occur. Leadership will keep group up to date on the
processes and purpose of interventions being used to allow the group to feel
and act as co-facilitators in their own group/self-work.
Concern and
Limitations
Like any therapeutic endeavor, it is impossible to say
with certainty what outcomes (if any) will be achieved. The set-up of the group is prone to some
limitations which could potentially cause regression to the group members or
possible harm to the therapeutic alliance.
Concerns include the following:
·
The groups’ use of leadership as both a
facilitator and a psychoeducator could potentially create a perceived power
differential in which the group/leader relationship is perceived as a student/
teacher relationship. This barrier will
be reduced by warmth, genuineness and appropriate, applicable self-disclosure
on the part of the leadership.
·
Although confidentiality and anonymity are goals
of the group, any group member threatening harm to self or others will require
immediate appropriate action on the part of leadership. Due to age of clients this may involve
disclosure to parents/guardians. This
barrier will be reduced by making clients aware of this policy throughout the
process, and encouraging clients to speak to parents/guardians with the
leadership present in instances where disclosure to guardians/parents is
necessary; this latter process will occur outside of the group process
·
Confidentiality is also harder to maintain in a
group setting. To try and reduce this
potential barrier, emphasis will be repeatedly placed upon the importance of
inter-group confidentiality. Any breaches
of confidentiality in the group will be dealt with as appropriate and the group
will be part of the process of dealing with breaches.
·
Using a highly integrative model comes with
restrictions as well. The combination of
CBT and ACT while mostly complimentary do have some offsetting
differences. Most notably is the
dissonance between the models views on thoughts. CBT focuses on stopping and changing negative
thoughts and refers to them as being maladaptive. On the other hand ACT focuses
on defusing from all thoughts, negative or positive and rather than placing
labels like maladaptive or negative on thoughts, the model simply looks for
value of thoughts. (I.e. is this thought helpful to me in this moment). The groups’ integrative approach will try to
utilize the best of both of these models by explaining to clients the
difference in models and encouraging clients to change unhelpful thoughts when
they can have non-judgmental acceptance of thoughts which cannot be
changed. The ACT concept of questioning
the value of thoughts rather than the legitimacy will be used in all instances.
Evaluations
Evaluations will
be accomplished via combination of several measures which will measure
internalized homophobia, shame and stage of sexual minority identity
development. Measures were chosen based on the research presented in the
article Stage of Sexual Minority Identity
Formation: The Impact of Shame, Internalized Homophobia, Ambivalence Over
Emotional Expression, and Personal Mastery (Greene & Britton 2012).
These measures will be administered as pre and post tests to create baseline of
group members and track personal development and growth. The Internalized Homophobia Scale (IHC)
(Martin & Dean 1987) will be used to measure pre and post levels of
internalized homophobia. Clients will also be administered a 10
question post group experience questionnaire which will be utilized to measure
clients’ perceived efficacy of the group experience. Shame will be measured using the Experience of
Shame Scale (Andrews, Qian & Valentine, 2002). The final empirical measure will be the Stage
Allocation Measure (Cass, 1984) which will be used to classify the stage of LGB
identity development of group members and to track their movement through
stages. These stages via the Cass model are as follows:
“Stages of identity are
defined as Stage 1 (Identity Confusion), Stage 2 (Identity Comparison), Stage 3
(Identity Tolerance), Stage 4 (Identity Acceptance), Stage 5 (Identity Pride),
and Stage 6 (Identity Synthesis)”. (Cass, 1984)
Conclusions
Due to the complexities which surround the minority
experience it will always be challenging to work with clients of minority
status. LGB individuals in particular
have a bevy of comorbid mental and physical wellness issues correlated with the
pressures caused by living in a heterosexist society. Group intervention with
an affirmative focus, and an ACT and CBT framework will allow clients to become
educated about their minority status, find helpful tools to navigate their
challenges, reduce internalized homophobia while increasing self-love, and grow
in a supportive community environment.
Reference
1)
Bowden, T., & Bowden, S. (2012).
Acceptance and Commitment Therapy (ACT): An Overview for Practitioners. Australian Journal Of Guidance
& Counselling, 22(2), 279-285. doi:10.1017/jgc.2012.32
2) Burns, D. (1999). The feeling good handbook (Rev. ed.). New
York, N.Y., U.S.A.: Plume.
*Taken from Sample Paper
3)
Craig, S. L., Austin, A., &
Alessi, E. (2013). Gay affirmative cognitive behavioral therapy for sexual
minority youth: A clinical adaptation. Clinical Social Work Journal, 41(3), 258-266.
doi:10.1007/s10615-012-0427-9
4)
Greene, D. C., & Britton, P. J.
(2012). Stage of sexual minority identity formation: The impact of shame,
internalized homophobia, ambivalence over emotional expression, and personal
mastery. Journal Of Gay & Lesbian Mental Health, 16(3), 188-214.
doi:10.1080/19359705.2012.67112
5)
Herrick, A. L., Stall, R., Chmiel, J.
S., Guadamuz, T. E., Penniman, T., Shoptaw, S., & ... Plankey, M. W.
(2013). It gets better: Resolution of internalized homophobia over time and
associations with positive health outcomes among MSM. AIDS And Behavior, 17(4), 1423-1430.
doi:10.1007/s10461-012-0392-x
6)
Jordan, K. M., & Deluty, R. H.
(1995). Clinical interventions by psychologists with lesbians and gay men. Journal Of Clinical Psychology, 51(3), 448-456.
doi:10.1002/1097-4679(199505)51:3<448::AID-JCLP2270510321>3.0.CO;2-8
7)
Langdridge, D. (2007). Gay
affirmative therapy: A theoretical framework and defence. Journal Of Gay & Lesbian
Psychotherapy, 11(1-2), 27-43. doi:10.1300/J236v11n01_03
8)
Lock, J. (1998). Treatment of
homophobia in a gay male adolescent. American Journal Of Psychotherapy, 52(2), 202-214.
9)
McGeorge, C., & Carlson, T. S.
(2011). Deconstructing heterosexism: Becoming an LGB affirmative heterosexual
couple and family therapist. Journal Of Marital And Family Therapy, 37(1), 14-26.
doi:10.1111/j.1752-0606.2009.00149.x
10) Meyer,
I. H. (1995). Minority stress and mental health in gay men. Journal Of Health And Social
Behavior, 36(1), 38-56. doi:10.2307/2137286
11) Pearson,
Q. M. (2003). Breaking the silence in the counselor education classroom: A
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Development, 81(3), 292-300. doi:10.1002/j.1556-6678.2003.tb00256.x
Appendix A: Session
Outlines
Session 1
Topic:
Introductions, rules and outline of treatment plan.
Goals: Group
members will get to know each other and the facilitator. Group members will
leave with an understanding of what the purpose of the group is, and what
expectations will be throughout treatment.
Materials/Handout:
A copy of expectations and contact information outlined in the consent form
(see appendix C).
Process:
- Group leadership will introduce themselves, and open the floor
for group members to do the same.
- Members will introduce themselves and share a high and low for
the day.
- New members will be welcomed into the group by the leadership and
group members.
- New members will be asked to share about themselves and what they
hope to accomplish through group membership.
- Group expectations will be reviewed.
- 10 minute break will occur following first 40 minutes.
- Group leadership will describe the processes and goals of the
group.
Session 2
Topic: A Psychoeducational look at internalized homophobia.
Goals: Introduce group to the concept of internalized homophobia.
Materials/Handouts: notebook, writing utensil,
Process:
- Group leadership will introduce themselves, and open the floor
for group members to do the same.
- Members will introduce themselves and share a high and low for
the day.
- 10 minute break will occur following first 40 minutes.
- Group leadership will introduce the topic of internalized
homophobia and its influence on the mental and physical wellbeing of
sexual minority individuals.
- Group members will be given open time to discuss topic as
facilitated by group leader.
- Group members will be asked to journal about a time they noticed
an instance of internalized homophobia in their lives.
- Session will close with an introduction to mindfulness via a
closing body scan to relax group members and help them learn to create
nonjudgmental awareness of thoughts and sensations.
Session 3
Topic: An introduction to cognitive
errors.
Goals: Members will learn about common
cognitive errors and maladaptive cognitive patterns.
Materials/Handouts: cognitive errors
handout notebook and writing utensils
Process:
- Group leadership will introduce themselves, and open the floor
for group members to do the same.
- Members will introduce themselves and share a high and low for
the day.
- Group members will be asked to share thoughts or excerpts from
last weeks’ journal assignment.
- A mindful body scan will be used to model and foster
nonjudgmental awareness/acceptance of thoughts and sensation.
- 10 minute break will occur following first 40 minutes.
- Group leadership will introduce the topic of cognitive errors and
its relation to internalized homophobia.
- Group members will be given open time to discuss topic as
facilitated by group leader. Examples of interventions to deal with
cognitive errors (i.e. reframing) will be discussed.
- Group members will be asked to journal about maladaptive thought
patterns and cognitive errors that they feel might be present in their
interactions with themselves and others. The handouts will act as a guide.
- Session will close with a body scan to relax group members and
model/ foster nonjudgmental awareness of thoughts and sensations.
Session 4
Topic: An introduction to attitudes of
affirmation.
Goals: Group members will learn gain an
introduction into the benefits of viewing themselves and other group members
through a gay-affirmative lens.
Materials/Handouts: notebook, writing
utensils
Process:
- Group leadership will introduce themselves, and open the floor
for group members to do the same.
- Members will introduce themselves and share a high and low for
the day.
- Group members will be asked to share thoughts or excerpts from
last weeks’ journal assignment.
- A mindful body scan will be used to model and foster
nonjudgmental awareness/acceptance of thoughts and sensation.
- 10 minute break will occur following first 40 minutes.
- Group leadership will introduce the topic of affirmation and its
importance in relation to internalized homophobia and LGB identity.
- Group members will be given open time to discuss topic as
facilitated by group leader.
- Group members will co-facilitate a gay-affirmative mantra for the
group.
- Group members will engage in active affirmation by telling each
other something affirmative about themselves and another group member.
- Group members will be asked to create a daily personal
affirmation in their journal. Homework will to be to say their created
affirmation out loud to themselves daily throughout the week, use of
mirror will be encouraged.
- Session will close with a body scan to relax group members and
model/ foster nonjudgmental awareness of thoughts and sensations.
Session 5
Topic: Acceptance and commitment.
Goals: Group members will be introduced
to ACT concepts of accepting thoughts, feelings and sensations which we cannot
control and evaluating their helpfulness.
Materials/Handouts: notebook, writing
utensil
Process:
- Group leadership will introduce themselves, and open the floor
for group members to do the same.
- Members will introduce themselves and share a high and low for
the day.
- Group will recite the gay-affirmative mantra they created last
week.
- Group members will be asked to share thoughts or excerpts from
last weeks’ journal assignment.
- A mindful body scan will be used to model and foster
nonjudgmental awareness/acceptance of thoughts and sensation.
- 10 minute break will occur following first 40 minutes.
- Group leadership will introduce the topic of acceptance and its
importance in relation to internalized homophobia and LGB identity.
- Group will listen as facilitator recites the ACT “monsters on a
boat” metaphor
- Group members will be given asked to identify the monsters that
are present on their boats, how they have dealt with them in the past, and
how they may deal with them differently in the future.
- Session will close with a body scan to relax group members and
model/ foster nonjudgmental awareness of thoughts and sensations.
Session 6
Topic: LGB Issues Day (Prejudice,
Stereotypes and Discrimination).
Goals: Members will learn the
difference between prejudice, stereotyping, and discrimination, gain an
understanding of how it effects their communities, and given a chance to
discuss instances in which they have been effected directly or indirectly by
these.
Materials/Handouts: notebooks, writing
utensils
Process:
- Group leadership will introduce themselves, and open the floor
for group members to do the same.
- Members will introduce themselves and share a high and low for
the day.
- Group will recite the gay-affirmative mantra they created by the
group.
- Group members will be asked to share thoughts or excerpts from
last weeks’ journal assignment.
- A mindful body scan will be used to model and foster
nonjudgmental awareness/acceptance of thoughts and sensation.
- 10 minute break will occur following first 40 minutes.
- Group leadership will introduce the topics of prejudice,
stereotyping and discrimination and its importance in relation to
internalized homophobia and LGB identity.
- Group will process direct and indirect personal experiences with
prejudice, stereotyping and discrimination.
- Group will watch “It Gets Better” video. Discussion of overcoming
heterosexism as a community will be introduced and briefly touched on
(Will be discussed in depth in future session).
- Session will close with a body scan to relax group members and
model/ foster nonjudgmental awareness of thoughts and sensations.
Appendix B:
Questionnaire
Client
Post-Treatment Survey
Please rate
your agreement on the following items according to the key below:
- Strongly disagree
- Disagree
- Neutral
- Agree
- Strongly agree
1.
I
have increased understanding of sexual orientation and sexual minority issues.
1 2 3 4 5
2.
I have come to a have a more accepting relationship with my sexuality.
1 2 3 4 5
3. I have been given tools in this
group which I believe will continue to benefit me.
1 2 3 4 5
4. I have decreased feelings of shame
and negativity surrounding my sexuality.
1 2 3 4 5
5. I have an increased self-love/ self-confidence.
1
2 3 4 5
6. Being in group has increased my
knowledge of resources available to me should I need counseling or group
support again in the future.
1 2 3 4 5
7. During my time with the group
I felt respected, heard and understood.
1 2 3 4 5
8. I felt that my group was well facilitated by group leadership.
1 2 3 4 5
9. I would recommend a group like this to others whom are dealing with
similar problems to those discussed in group.
1 2 3 4 5
10. I felt that I could speak freely in group and do my work without
feeling judgment from group facilitators or members.
1 2 3 4 5
Appendix C: Informed
Consent Form
Informed Consent & Agreement
to Treatment Form
Group counseling can be an effective tool in offering reduction of
internalized homophobia; this is the purpose of the proposed group. Treatment
will be structured around a combination of psychoeducation and therapeutic intervention. The techniques used in the group will work
from a cognitive behavioral perspective, offering a structure which will work
toward reduction of symptoms via cognitive restructuring, and intervention. The treatment plan will be supplemented with
Acceptance and Commitment Therapy techniques and Gay-Affirmative techniques to
encourage growth and self-love. As the
process component is highly experiential, attendance at group sessions is
strongly encourage. Group counselors are held to the ethical standards of the
American Counseling Association as such confidentiality and safety of group
members is a foremost importance to group leadership. Confidentiality can potentially be broken by
the group leadership under special circumstances in which a group member is a
danger to themselves or others and instances of abuse. In the case of abuse of a child (which is
defined here as any individual under the age of 18) the group leader must act
as a mandatory reporter on behalf of the child and file a report with Child
Protective Services. Unlike individual counseling a group setting presents an
extra potential for confidentiality breech in that group members are not
trained counselors and may breech group trust. To minimize this risk all group
members are explained the following group expectations:
1) By signing below and agreeing to take
part in this group you understand that confidentiality is an expectation
presented in the group environment and agree not to breech confidence of the
group. This means that all group members
will abstain from disclosing anything group related (topics, identities of
group members, etc.) outside of the group setting or to anyone not in the
group. As a group member, it is expected that you will hold to the group
agreement to confidentiality.
2) Group members will avoid unnecessary
confrontation and unnecessary aggression in dealings between group
members. Group members will be taught
how to engage each other in a respectful, caring and warm way.
3)
Group
members understand that inability to abide by above mentioned expectations may
result disciplinary action including termination from treatment
Any and all questions may be directed
toward group leadership, Jared Smith via email or to his program director via
email in the case of possible conflict of interest.
Acknowledgement and
Consent
I have read and understood the synopsis of this group and I hereby
consent to participate in group treatment and to follow the aforementioned
guidelines.
_______________________________________________ _________________
Signature
of Client Date
Appendix D: Resource Examples
Excerpt describing Internalized Homophobia Scale (Greene & Britton,
2012)
“INTERNALIZED
HOMOPHOBIA SCALE Martin and Dean (1987) developed the Internalized Homophobia
Scale based upon criteria for ego-dystonic homosexuality as defined by the Diagnostic
and Statistical Manual of Mental Disorders (American Psychiatric Association,
1980). The nine-question instrument asks questions such as, “I feel alienated
from myself because of my being lesbian/bisexual [gay/bisexual]” or “I feel
that being lesbian/bisexual [gay/bisexual] is a personal shortcoming for me”.
Items are measured on a 5-point Likert scale ranging from 1 (strongly disagree)
to 5 (strongly agree), with higher scores indicative of greater internalized
homophobia. Originally written for gay and bisexual males, the scale has been
expanded to also include lesbians and bisexual women (Herek, Cogan, Gillis,
& Glunt, 1997). Internal consistency has been demonstrated to be adequate
for gay men and lesbians (α = .85; .71, respectively), and validity is
evidenced with IHP correlative to lower self-esteem and outness in gay men and
lesbians (Herek et al.), and lower importance attached to community
involvement, higher dissatisfaction with the local gay and bisexual community,
and higher depressive symptoms in gay men. Cronbach’s α in the present sample
was .90”.
Excerpt describing
Cass Stage Allocation Measure (Greene & Britton, 2012)
“STAGE
ALLOCATION MEASURE: The Stage Allocation Measure (Cass, 1984) consists of
paragraphs describing characteristics typifying Cass’s theoretical stages of
identity development and a noncoded or 0-coded description of heterosexual
identity that begins, “You believe that you are heterosexual and never question
this.” Stages of identity are defined as Stage 1 (Identity Confusion), Stage 2
(Identity Comparison), Stage 3 (Identity Tolerance), Stage 4 (Identity
Acceptance), Stage 5 (Identity Pride), and Stage 6 (Identity Synthesis). The
Stage Allocation Measure was determined by Cass (1984) to have content,
concurrent, and construct validity. In her validity study, while some blurring
was found between Stages 1 and 2 an between Stages 5 and 6, discriminate
analysis evidenced stage differentiation and accuracy of stage sequencing
through comparison with the Homosexual Identity Questionnaire, an additional
instrument developed by Cass (1984). Participants rate themselves as to which
description “best fits you currently” from 0 to 6. The Stage Allocation Measure
(SAM) produces categorical data based upon self-definition, as well as a scale
score of stage development given assumptions of linear progression.”
Excerpt Describing
Experience of Shame Scale (Greene & Britton, 2012)
“EXPERIENCE
OF SHAME SCALE Shame was assessed using the Experience of Shame Scale (Andrews,
Qian, & Valentine, 2002), a 25-item questionnaire assessing
characterological shame, behavioral shame, and body shame. The Experience of
Shame Scale also includes a total score indicative of shame-based identity,
which was used for this study. Characterological shame includes items involving
shame and personal habits, shame and manner with others, shame about what sort
of person you are, and shame about personal ability. Behavioral shame includes
items referring to doing something wrong, saying something stupid, and failing
in competitive situations. Bodily shame measures shame regarding one’s body.
For each shame area presented, there are three questions addressing
experiential, cognitive, and behavioral components. Items include “Have you
felt ashamed of any of your personal habits?” and “Have you tried to conceal
the sort of person you are?” with respondents answering from 1 (not at all) to
4 (very much). Total scores showed a high internal consistency (Cronbach’s α
=.92), and test-retest reliability was .83. Validity was demonstrated by
testing for depression using the SCL-90 (Derogatis, 1983) at time 1 and time 2
at an interval of 11 weeks. Both time periods evidenced significant moderate
correlations, as well as a significant moderately high correlation between the
Experience of Shame Scale and the Test of Self-Conscious Affect-Shame (Tangney,
Wagner, & Gramzow, 1989). Cronbach’s α in the present sample was .95.”
It Gets Better Video Link
Cognitive Error Worksheets
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