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Specializing in LGBTQ Treatment

Specializing in LGBTQ Treatment. Presented at NAADAC, 2014 – Seattle, WA. Monica O’Connell, MA, LMFT, LADC, Behavioral Health Supervisor at PRIDE Institute in Minnesota. A bit about PRIDE Institute. Who we are.

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Specializing in LGBTQ Treatment

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  1. Specializing in LGBTQ Treatment Presented at NAADAC, 2014 – Seattle, WA Monica O’Connell, MA, LMFT, LADC, Behavioral Health Supervisor at PRIDE Institute in Minnesota

  2. A bit about PRIDE Institute

  3. Who we are • For over 28 years, PRIDE Institute has *exclusively* helped the LGBTQ population through substance abuse and mental health treatment programs. • Located just 10 miles from  the Minneapolis city center,  PRIDE takes a holistic approach in serving the LGBTQ population, offering Dual Diagnosis licensure, 24-hour nursing care in a serene, retreat-like setting with a nationally recognized clinical staff. • In addition, we are a renowned teaching facility with an average of 8 interns on staff at all times • Monica O’Connell MA, LMFT, LADC • Mental Health Supervisor, PRIDE Institute • EMDR trained therapist & consultant in training

  4. A bit about PRIDE Institute Our treatment program is preferable to “one-size-fits-all”, mainstream programs that do not understand or address issues specific to LGBT individuals.   Contact PRIDE Instituteat 1-800-547-7433 www.pride-institute.com

  5. Specializing in Crystal Meth and Sexual Compulsivity programming Body Image Sexual Health program HIV/AIDS Programming 3 day Family immersive weekend PRIDE Sober Support Program. Offering TRAUMA-INFORMED Care

  6. Objectives • Understanding LGBTQ inclusive identification and terminology • Discuss impact of trauma (e.g., internalized homophobia, micro-aggressions, bullying) on LGBTQ clients and their resulting chemical use. • Identify best practices to serve the LGBTQ community, including specialized and exclusive services.

  7. Just the Facts • 30-40% of the LGBT Community is addicted, in contrast to 10 percent of the population at large • 46% of lesbian and gay men in treatment have had homophobic therapist • 34% felt their sexuality was seen as irrelevant • 7% had therapist who made openly negative comments about their sexuality

  8. LGBTQ • Definitions: Lesbian, Gay, Bisexual, Trans*, Queer • Understanding Client’s: • gender • sexuality • expression

  9. Defining Transgender • Transgender is an umbrella term for people whose gender identity differs from what is typically associated with the sex they were assigned at birth • Being transgender is not dependent on medical procedures or the taking of hormones

  10. TERMINOLOGY • Assigned Sex at Birth: a person's sex is determined by a number of factors - not simply genetics - and one's biology does not "trump" one's gender identity. People are born babies - they are not "born a man" or "born a woman.“ • Transgender: people whose gender identity, expression or behavior is different from those typically associated with their assigned sex at birth. • Cisgender: A term used by some to describe people who are not transgender. "Cis-" is a Latin prefix meaning "on the same side as," and is therefore an antonym of "trans-." • Gender Non-conforming: individuals whose gender expression is different from societal expectations related to gender.

  11. PRONOUNS • Trans Woman: trans individual that identifies as a woman • Trans Man: trans individual that identifies as a man • Genderqueer: used by some individuals who identify as neither entirely male nor entirely female • Two Spirit: People who display characteristics of both male and female genders. Sometimes referred to as a third gender – the male-female gender. The term is derived from the traditions of some Native North American cultures.

  12. LGBTQ, Trauma & Addiction • High incidence of trauma in LGBTQ community • Increased rates of trauma for LGBTQ individuals who use chemicals. • Trauma and addiction memories

  13. LGBTQ-Specific Trauma Imprints • Heterosexism • Bullying • Attachment injuries related to identity within the LGTBQ community • Homophobia • Transphobia • Internalized Homonegativity

  14. Chemical Use Starting as a Solution • Client’s describe use memories and earliest use periods to include reasons such as: • “Then I could fit in.” • “I was so isolated and this helped me feel numb.” • “It was the first time I felt like I was attractive and could really be free to be myself.”

  15. PRIMARY goal of treatment is to create Client Safety • Trauma-informed Care • Addressing Internalized Homonegativity • Creating an environment of inclusion through LGBTQ-informed & specialized care • Mental Health • Shame • Body image • Healthy relationship models

  16. TREATMENT Interventions • Creating community through LGBTQ exclusive environment and addressing: • Sexual Health • Trauma • Mental Health • Shame • Body image • Healthy relationship models

  17. SEXUAL HEALTH And the necessity of • Re-introducing intimacy definitions • Sex Positive experiences & conversations • Emphasis on re-defining sexual health

  18. TRAUMA • Helping client’s understand trauma • ‘Big T’ trauma; ‘little t’ trauma; community violence and trauma • Trauma occurrence during developmental tasks • Coming out stories • Family response to identification in the community

  19. MENTAL HEALTH • Understanding the impact of mental health on the LGBTQ community and chemical health • Examining mental health diagnosis and the LGBTQ community • Early diagnosis vs. coming out stories • Chemical use induced symptoms vs mental health • Complex trauma vs. Axis II diagnosis

  20. BODY IMAGE • Impact of culture on body image • Understanding body/gender dysphoria • Use of chemicals in reference to body image

  21. HEALTHY RELATIONSHIPS • Defining Self within relationships • Allowing Clients to define “Family” & “Relationships”

  22. LGBTQ Considerations • Inclusive lodging (bedrooms, gender neutral bathroom facilities) • Informed paperwork and assessment questions • Addressing family of origin & family of choice

  23. Exclusive & Inclusive Treatment Models • Priority placed on meeting the client’s specific needs. • Creating safety in client groups and relationships. • Easier in exclusive environments • In an inclusive environment, institution needs to address heterosexual privilege and its presence in groups

  24. Exclusive & Inclusive Treatment Models LGBTQ-informed Staff • Starting at intake • Specific LGBTQ training • Trans* specific education

  25. What is Heterosexism • System of attitudes, bias, and discrimination in favor of opposite-sex sexuality and relationships. Where being heterosexual is the “norm”. • What is Heterosexual Privilege? • Can you give examples of Heterosexual Privilege?

  26. Example of Heterosexism • Assuming everyone is heterosexual. • Discrimination against lesbians, gays and bisexuals. • Assuming heterosexual “norms” apply to all people, relationships and situations.

  27. Privilege • White Privilege • Male Privilege • Female Privilege • Straight Privilege Other Privilege lists: http://www.amptoons.com/blog/archives/2006/09/26/a-list-of-privilege-lists/

  28. Body Image • Understanding Body/Gender Dysphoria in the Trans* community • Use of drugs & alcohol in reference to body image • Understanding the culture of body image and how it relates to LGBT individuals

  29. Grief and Loss • Rejection of family/friends • Sexual abuse/violence • Unspeakable deaths • Loss of Relationships • Loss of self • Death of significant people/pets • Loss of community • Loss due to sobriety

  30. Anxiety and Depression • LGB individuals have higher rates of co-occurring disorders than heterosexual individuals • 62% of Transgender people have experienced depression • 41% of Trans* people have attempted suicide in comparison to 1.6% of the general population • Understanding the brain chemistry as well as the environmental struggles of anxiety & depression

  31. Shame • “Shame corrodes the very part of us that believes we are capable of change.” -Brene Brown • Understanding how shame keeps us isolated and addicted

  32. Sexual Health • Importance of talking about sex in treatment • Struggles with/and understanding Intimacy • Sexual Compulsion • Sexual Anorexia • Setting specific goals with regards to sex and relationships with a sex-positive approach

  33. Trauma • Fear of violence • Bullying • Emotional abuse • Effects of Invisibility • Sexual violence/abuse • Physical violence/abuse • Domestic violence/abuse • Institutionalized Harassment

  34. Resources • TransMontana by Roberta Zenker • Second Son by Ryan Sallans • My Gender Workbook by Kate Bornstein • A Queer and Pleasant Danger by Kate Bornstein • Transgender History by Susan Stryker • Running on a Mind Rewired by Nate Cannon • Trans (Documentary) • Just Gender (Documentary)

  35. Questions?

  36. References • www.itspronouncedmetrosexual.com • www.avp.org • www.fenway.org • www.nalgap.org • www.runningrewired.com • www.transmontanathebook.com

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