Perspective Chapter: Helping BIPOC LGBTQIA+ Families through Inclusive Therapy and Advocacy

Abstract

Families are phenomenological and unique. All families are valuable, but historically, many family types have been underrepresented. Families with members who identify in the BIPOC LGBTQIA+ communities have historically been underrepresented and marginalized. Helping BIPOC LGBTQIA+ families involves both clinical work and advocacy. Advocacy for the professional identity of counseling, marriage and family therapy, and related helpers involves various aspects. These aspects include leadership theory and integration, importance of professional identity, the need to continue to infuse multiculturalism within the counseling and family therapy identities, and continued skills for counselors to learn inclusive advocacy. Skills and implications for advocacy as they relate to clients who intersect among the LGBTQAI+ and BIPOC communities, will be described.

1. Introduction

Advocacy and leadership have become increasingly recognized, in part, due to the growth of knowledge and awareness from leaders in the family counseling fields [1]. Leadership theories and types have evolved from a traditionally innate sense of personality to a now more explicitly learned set of competences that counselors and family therapists use with increased intentionality. Leadership, specifically, is now seen by helpers as not a single action, but rather an on-going dialog or a learned set of skills or behaviors [1, 2, 3]. Counselors and family therapists must focus on increasing their professional leadership, identity, and advocacy to best help all family types.

Definitions of leadership in family counseling have expanded to include cultural responsivity and social justice [4, 5]. Cultural responsivity includes cultural sensitivity, cultural knowledge, cultural empathy, cultural guidance, and, most recently, cultural humility [6, 7]. Similarly, social justice is increasingly being incorporated into counselor education, counseling psychology, and marriage and family counseling literature [8]. To date, however, there is still limited understanding, research, and enactment of social justice measures in all these related fields [9]. Of the knowledge currently enacted, scholars have identified multiple sub-constructs of social justice, including affirmative action, emphasis on equality, decolonization, and disruption of marginalization, oppression, and inequality [9]. In the below documentation, various aspects of leadership skills and ideas will be described as they relate to multiculturalism and inclusive advocacy. These types could also be applied to underrepresented clients and families, including BIPOC LGBTQIA+ families.

2. Traditional leadership theories in family counseling

Various leadership theories drive different forms of advocacy in family counseling. Leadership theories efficacious for family therapists and counselors include: 1) Trait Theories, 2) Behavior Theories, 3) Contingency Theories, 4) Path-Goal Theory, 5) Leader-Membership Exchange Theory, and 6) Supervision Leadership models [10, 11]. Though each of these leadership theories is different, each theory can be effective depending on congruency to a counselor’s, family therapist’s, or leader’s personality and preferred leadership style. For example, Trait Leadership Theory includes various salient traits of a family counselor leader, such as extraversion and emotional intelligence. Comparatively, other Behavioral Theories focus on behaviors learned and used by effective leaders, rather than on personality or emotion-based traits, alone. Additionally, Contingency Theories focus on traits and behaviors, as well as context and other significant relational factors (e.g., sociocultural considerations) with those whom family counselors will serve and lead [10]. Additionally considered is Supervision Leadership, which uses culturally responsive leadership models and practices [11]. One of the greatest improvements in family counseling and other counseling fields includes the increase of educating colleagues and trainees about the need to incorporate all leadership models with culturally responsive and just components. Recently, leaders in the field have begun incorporating the Socially Just and Culturally Responsive Counseling Leadership Model (SJCRCLM) in addition to the recently described models [11]. This chapter will emphasize ideas congruent with the SJCRCLM designed for clients and families in the BIPOC LGBTQIA+ community.

3. Importance of inclusive leadership practices

To supplement professional identity and leadership modeling, leaders in family counseling and related fields must also understand and establish ethical and culturally relevant practices in those fields [12]. The American Association for Marriage and Family Therapy (AAMFT) Code of Ethics emphasizes inclusiveness and diversity in many ways, including diversity being listed as one of AAMFT’s main aspirational core values [13]. Furthermore, the International Association of Marriage and Family Counselors (IAMFC) and American Counseling Association (ACA) also explicitly mention valuing diversity and cultural competency [12]. Furthermore, the ACA’s Code of Ethics requires that counselors be continuously ethically and culturally competent. These competencies are specifically aligned in Standards A.2.c., B.1.a, C.2.f, E.5.b., E.8., F.2.b., F. 11.c. and H.5.d [12]. Culturally relevant history that need to be increasingly taught in family counseling programs include the development of the Association of Non-White Concerns (ANWC) in 1985, the development of the Multicultural Counseling Competencies and Standards (MCCS) published in 1992, the formation of the Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling (i.e., SAIGE, then known as AGLBIC) in 1997, and others [10]. Family counselors must also recall the ACA Code of Ethics: Standard E.5.c, which is to “recognize historical and social prejudices….” While critical social justice efforts are gaining awareness, multiculturally competent advocacy for clients and professionals remain lacking. Thus, ultimately, family therapists and counselors must all embrace their organization’s professional identity, which each include to best serve clients of all cultures. As mentioned, infusing the SJCRCLM and adapting traditional leadership and service models to be increasingly inclusive is a need in all related mental health fields.

4. Assessing family counselor culturally relevant leadership practices

Both trainees as well as seasoned professionals should be encouraged to consistently create an affirming clinical environment by teaching about the effects of context, semantics, and positions of privilege [14]. Usage of assessments and group dialog in family work can be increasingly helpful to understand some of these systemic factors [15]. One such assessment that can be used in family counseling or individual counseling supervision is the Multicultural Competencies Self-Assessment Survey or related multicultural surveys [16]. Another professional advocacy assessment includes the Advocacy Competencies Self-Assessment Survey, which helps counseling trainees or counselors assess their capabilities of being advocates and culturally focused versus lacking in these areas [17]. Administration of the above assessments are two potential ways to address both client and professional advocacy using a systemic and cultural emphasis. Another culturally relevant and ethical practice needed by family counselors is the continued establishment and maintenance of ethical boundaries (ACA, 2014; CACREP, 2016). Specifically, per the 2014 ACA Code of Ethics, family and individual counselors are required to establish and maintain differentiated boundaries between their personal and professional roles, especially when implicit biases due to cultural differences may exist [12, 18]. In all family sessions, boundaries of the family counselor need to be distinguished, rather than left tacit and confusing. Sometimes, due to the systemic nature of families, dual roles may occur; however, all roles should be navigated with caution, consultation, and clear communication. Other culturally inclusive ethical strategies include modeling being an advocate for multicultural awareness, facilitating in-session activities about family and culture, and emphasizing the need for cultural awareness in supervision, class, and clinical practice [10, 19].

5. Advocacy to address salient socio-political issues affecting LGBTQIA+ clients and families

Client advocacy is another needed leadership skill for family counselors [10]. It is imperative that clinicians remember the term “multicultural” is inclusive of issues relating beyond outward differences alone [20]. With understanding that identity transcends beyond phenotype, family counselors must be advocates for all individuals of a family, especially those who are marginalized in larger society. For example, due to recent legislative policies, one demographic of people who are still marginalized in current society includes people identifying as, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, or Asexual (LGBTQIA+) [10, 20]. With same-sex marriage recently legalized in the United States, individuals often forget that discrimination toward LGBTQIA+ people has not ceased in America. One example that exemplifies how individuals in the LGBTQIA+ group are still unjustly marginalized, is the example of recent formation of discriminatory legislation, Florida House Bill 1557 or otherwise known as the “Don’t Say Gay Bill.” This Bill states that classroom instruction about sexual orientation or gender identity may not occur at all in Kindergarten through Grade Three [21]. Additionally, as of 2022, at least three states in America, including Georgia, Florida, and Alabama do not ban conversion therapy [22]. Not long ago, too, in 2016, former Governor, Bill Haslam of Tennessee, signed a law into place that allowed private practice family or individual counselors to not have to work with clients of whom they disagree with ideologically, religiously, or regarding sexual orientation, despite the client’s presenting issues or need [23, 24]. More specifically, counselors in Tennessee, who may be approached with clients who are gay and with a presenting issue, such as severe depression or suicidality, may refer out this counseling seeking client, only due to disagreeing with his, her, hir, or their lifestyle, sexuality and/or gender expression, alone [23, 24]. This Bill is denounced The American Counseling Association. However, despite professional advocacy, this Bill symbolizes the large margin of current advocacy work that is still needed in the counseling profession. Thus, in many areas of the United States, clients in the BIPOC and LGTBQIA+ population are still marginalized.

6. Intersection of BIPOC and LGBTQIA+

LGBTQIA+ individuals who are also racial/ethnic minorities are multi-marginalized and are often subject to microaggressions associated with the intersection of their two historically oppressed identities [25]. On average, sexual minority people of color experience less support, greater stress, and fewer resources than White LGBTQIA+ individuals [26]. BIPOC LGBTQIA+ members also experience increased family rejection [27] and have a greater tendency to conceal their sexual orientation [28]. These “double minority” individuals encounter mental health challenges linked to sexism, racism, cis-heteronormativity, and challenges related to oppression toward their intersecting identities. While culture and community connections (including the presence of role models and family/peer support) improve resiliency, fears of “losing face,” unwillingness to disclose ill health, and mental health providers’ lack of cultural competency, create barriers to effective mental health support for these individuals with these intersecting identities [10]. Considering the disparity of services provided to BIPOC LGBTQIA+ identifying individuals and their families, it is crucial that family counselors advocate. Additionally, family counselors need to continue to learn to adequately conceptualize the unique variation of overlapping identities when beginning work with any new client of family. Relatedly, sexual, and racial minorities make up a disproportionately large percentage of the United States’ incarcerated population. Black males make up approximately 13 percent of the population, yet account for 34 percent of the total male prison population [29]. In 2017, 9.3 percent of men and 35.7 percent of women in prison identified as sexual minorities, compared to less than 4 percent of incarcerated White women within the U.S. Additionally, gay Black men have twice the incarceration rate compared to their White, non-racial minority counterparts [29]. Since individuals who face the dual minority status of being both a racial and sexual minority face a significantly disproportionate risk of jail time, it is critical that family counselors recognize the disparity and advocate with these clients. Risk of incarceration is only one marginalization experienced for clients and families identifying within the BIPOC and LGBTQIA+ community. A growing body of evidence documents the negative effects of racism on the emotional, psychological, and physiological functioning of BIPOC families [30]. Psychological distress (e.g., anxiety, depressive symptoms) due to perceived racial discrimination is more prevalent among BIPOC students and families than their White peers and families [31]. Other barriers include, racial injustice, and discriminatory practices in schools, workplaces and [32, 33]. Additionally, Black mothers have higher rates of preterm births, indicating higher risks for health complications among Black children from the start of life [34]. Once born, Black children are also less frequently exposed to culturally appropriate childcare and are often racially profiled as aggressive in various arenas, which often escalates into more police-based discrimination as these children age [35, 36, 37]. Considering all these stressors and traumas, BIPOC families frequently endure ambiguous, non-death losses, or “losses that remain unclear and thus without resolution,” such as historical trauma, below-average academic opportunities, and oppressive laws and policies [38]. Thus, effective professional family counselors must learn to employ a trauma-informed and culturally responsive modality for BIPOC LGBTQIA+ clients and their families.

7. Leadership and family counseling strategies as advocacy

Advocating for BIPOC LGBTQIA+ individuals and their families by refuting punitive and discriminatory legislation such as Florida Bill 1557 and Tennessee Bill 1556, as well as intervening and preventing less covert and overt acts, is needed by all family counselors. Speaking with legislators and other public individuals is a crucial advocacy component that is needed by clinicians in our field, but not currently mandated. These actions are rooted in family counseling education and the AAMFT and ACA Code of Ethics. As counselors and related mental health clinicians have mentioned prior, when counselors see oppression, we must accept responsibility for individual and collective social action. Various systemic related resources for family counselors and their family clients include the following:

1. Psychoeducation Family counselors seeking consultation about increased knowledge is needed. Additionally, family counselors who provide psychoeducation to BIPOC LGBTQIA+ families are also needed. For example, prior researchers have found that biracial children often experience more identity-confusion when White parents do not foster their Black identity development [39]. Opposite of minimizing a child’s ethnicity, family counselors should encourage parents in these families to reflect their biracial or BIPOC child’s ethnic strengths and marginalized identity [40]. One concrete resource that can be used among family counselors is called The Safe Place [41]. The Safe Place is a free app that was created by Jasmin Pierre in 2018. The Safe Place is focused on psychoeducation and self-care for people who identify in the Black community [4, 41]. The Safe Place is geared toward the Black community and initially invites group discussion about mental health. Users of this app can navigate different parts of the application to see features such as, Black mental health prevalence and statistics, ways to cope, ways to engage in self-care, ways to cope after experiencing or witnessing police brutality, suggestions for meditation and ways to seek additional support through nontherapeutic resources such as, church or through suggestions of mental health professionals. More information about The Safe Place can be found here: https://blackgirlnerds.com/minority-mental-health-app-the-safe-place. Additionally, a recent meditation application called Liberate: Black Meditation App is a free app designed specifically for the BIPOC community and led by BIPOC teachers. Liberate was designed by Julio A Rivera in 2018 to provide wellness support for people from the BIPOC community. This app provides meditations for users, along with videos of hope and insight from yoga instructors and other contributors. Meditations specifically designed to help users deal with microaggressions and trauma related to societal racism are also utilized. Other meditations are also designed to help users embrace, reconnect, and honor their often-underrepresented varying heritages. More information about Liberate can be found here: https://www.washingtonpost.com/lifestyle/magazine/think-meditation-could-help-cope-with-microaggressions-theres-an-app-for-that/2020/03/31/b28ba252-5fb8-11ea-b014-4fafa866bb81_story.html

2. Being Trauma Informed Family counselors need to continue to learn how to help families dealing with trauma related to intersecting isms. Various isms that BIPOC LGBTQIA+ families may experience, include lack of physical access to resources due to discrimination, overt and covert racism, sexism, homophobia, transphobia, and chronic microaggressions [4, 25, 42]. A specific traumatic occurrence that impacts BIPOC LGBTQIA+ communities is police brutality [42]. As of 2020, BIPOC were killed at least 1.6 times the rate of their White peers. Additionally, Black men and Native American men were killed at almost 3 times the rate of White men by police. Family counselors should consider both the psychological and physical wounds that police brutality may trigger for many BIPOC and BIPOC LGBTQIA+ clients and families [42]. Furthermore, typical broadcasting does not usually cover the hate-crimes, violence, and grief related to oppressions surrounding BIPOC LGBTQIA+ communities. Being trauma-informed and having cultural competence, humility, composure, quick wittedness, creativity, persistence, assertiveness, and resilience are all ingredients of successful family counselors [43]. Family counseling that already intentionally incorporates trauma has already proven beneficial in recent literature [44].

3. Recognizing Representation Family counselors need to help mitigate the lack of representation that many BIPOC LGBTQIA+ members and families experience in mental health support and healing services. BIPOC, LGBTQIA+, and BIPOC LGBTQIA+ folks are often excluded from public media, as well as media surrounding grief and loss support [45, 46]. For example, a protective factor and supportive organization for many clients and families includes the Trevor Project. The Trevor Project is the largest suicide and crisis prevention intervention program for LGBTQIA+ youth in the world. Though this organization is very helpful, many clients in the BIPOC LGBTQIA+ community have shared that this organization, too, lacks representation as it was catalyzed primarily by Trevor, a White fictional character [47]. Thus, for family counselors to recognize the loss of Trevor and helpfulness of the Trevor Project, while also recognizing the impact of lack of representation on all BIPOC LGBTQIA+ individuals in this and other organizations, is crucial. Increasing representation not only includes representation of BIPOC LGBTQIA+ families and individuals, but also family counselors as advocates.

4. Advocacy Outside of the Counseling Session Family counselors can act as advocates by talking with legislators about terminating discriminatory Bills such as the: Tennessee Bill 1556 Senate Bill (i.e. which does not require counselors to help families or clients who conflict with their religious beliefs), Missouri Senate Bill 1721 (i.e. which prohibits anyone from gender reassignment surgical procedures under age 18), Georgia Senate Bill 368 (i.e. which excludes LGBTQIA+ foster parents from adopting when placement of a child violates certain religious or moral convictions of the fostering agency), Arkansas Stop CRT Act of 2021 (i.e. which would defund and prohibit efforts to teach about history though non-White lenses, like Critical Race Theory), and HR6243 No More Free Ride Act (i.e. prohibiting Federal public benefits for or naturalization of any person who received a payment pursuant or related sources) and others [4, 21, 22]. Family counselors are encouraged to pursue a congruence between their prosocial behaviors in both their professional and personal selves.

5. Increasing Competence and Providing Supportive Resources to Families Family counselors are also expected to help families find physical and psychological support in and outside of the counseling session. Organizations in support of BIPOC LGBTQIA+ affirming counselors, community families, and community members include, but are not limited to 1) the Society for Sexual, Affectional, Intersex, and Gender Expansive Identities (SAIGE), 2) National Queer and Trans Therapists of Color Network (NQTTCN), 3) The National Black Justice Coalition (NBJC), and 4) The National Center for Transgender Equality (NCTE). SAIGE is a division of the American Counseling Association which offers information and support for both counselors in the LGBTQIA+ community and their allies [48]. Another impactful organization, the NQTTCN is a nonprofit agency formed in 2016 that provides support and therapeutic services to queer and transgender people of color (QTPoC) [4]. Additionally, The National Black Justice Coalition (NBJC) is a federal civil rights-based group that was founded in 2003 and focuses on empowering Black lesbian, gay, bisexual, transgender, queer+, and same gender loving people. The NBJC engages in advocacy for federal policy change, research, and education [4]. Family counselors educating themselves, professionally, through groups, such as the NBJC is encouraged. Additionally, family counselors providing these names of supportive groups to family clients may also provide education, universality, and hope. Another influential entity is the National Center for Transgender Equality (NCTE). The NCTE is a social justice organization founded in 2003 that advocates for transgender and nonbinary people [4]. The NCTE facilitates a variety of developments, including the Racial and Economic Justice Initiative (REJI), which advocates for change for transgender people of color experiencing rural and urban poverty (among other obstacles). These are only four of various emerging advocacy groups where family counselors can collaborate and connect clients and families.

8. Conclusion

As referenced throughout this documentation, family counselors’ inclusive and multicultural based advocacy, leadership, and clinical practice are needed when working with underrepresented families, especially BIPOC LGBTQIA+ families. Leadership theories and types have evolved and continue to influence the work that family counselors do in this and other areas. Unfortunately, in theory, there will always be societal constraints and power inequities; because of these inequities, however, there will always be a reason for family counselors to unite professionally and clinically advocate for BIPOC LGBTQIA+ families!

Acknowledgments

The authors would like to thank all Northern Illinois University and Northwestern mentors who encouraged advocacy and passion for this subject!

Conflict of interest

The authors declare no conflict of interest.